Advice When Submitting a Claim

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Advice When Submitting a Claim

Post by Dove96 on Wed 02 Jul 2014, 10:05

I highly recommend anyone submitting a claim or goes through an appeal reads the Tables of Disabilities for guidance. (This was recommended by my Advocate prior to one of my appeals.)

This helps to clarify what you want to say about your condition into VA speak. Kind-a like writing a PER - there are key phrases and words that let you know where you stand without knowing the score.

I found that reading the tables gave gave me a better understanding of the rules VA uses.
For example:
Table 19.7 - Other Impairment - Chronic Pain
Rating 4: Requires ongoing medical monitoring and requires medication on a regular basis and has good response to treatment.
Rating 9: Requires ongoing medication on a regular basis but has only partial or inadequate pain relief with requirement for occasional break through pain medication.

I knew that my meds kept pain at 3-4/10 which I considered "tolerable".  A storm, stress, overwork, too much exercise and I could go to an uncontrolled 8 or nine very fast. I would have to take extra medication for this pain. When asked if my medication was working I would simply say yes.

Apparently without understanding the rating system my saying yes my medication is working would put me at a "4".
I was receiving "partial" relief and the word for these episodes of uncontrollable, intolerable, please kill me now pain was "Breakthrough pain"
If I hadn't read the table I would've dismissed what I consider a "tolerable" level of pain and missed that "phrase" which was the fine line between a "4" and a "9". That would make a big difference in the final outcome.

Hope this helps.

Link to Tables
http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/table-of-disabilities

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Re: Advice When Submitting a Claim

Post by Teentitan on Wed 02 Jul 2014, 10:21

My advice on filling out an application, appeal, QOL questionnaire etc do not get "wordy".

Remember your application is broken down into ticks in a box for the adjudicators to make their decisions. So too much of an explanation works against you. That's why some of the boxes on applications are too small and subconsciously it makes you get wordy because you now have a blank piece of paper in front of you and your brain wants to fill the whole page.

As Dove stated to get the idea look at the TOD's to wrap your head around it. As my doctor said when I handed over the TOD for back injury "And I thought WSIB was bad."
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Re: Advice When Submitting a Claim

Post by pinger on Wed 02 Jul 2014, 13:03

You are very right teen " do not get "wordy". " and what you say is crucial. A legions S.O. saw my " use the additional space below if required " (I had 4 freaking pages!). He said forget that shyte.
Furthermore, when you answer those forms and tick those boxes... use your absolutely WORST, WORST, DAY. I.E... I can't walk. It don't seem right to me but where will fighting clean getcha in a dirty fight? Too bad the TOD has to be so darned anally wordy though, but maybe it's a neccesary evil? pinger.
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Re: Advice When Submitting a Claim

Post by Teentitan on Wed 02 Jul 2014, 13:20

The root of the whole problem is the adjudicators!
Not medically trained, they use the Merck manual (basically a medical dictionary), and a small spectrum of medical conditions.

I have sarcoidosis, an autoimmune disease that kills from the inside by slowly killing organs. Yet I am assessed for a person with tuberculosis. Sarcoid is a common disease that can attack any...any internal organ. TB does not. So my disease is so far over the heads of the adjudicators I will never get a fair shake on a proper assessment because to the adjudicators I have TB.

So until medically trained people, minimum a trained RN, are employed as adjudicators you have to use small words to describe a big health problem.

Being honest with a full explanation only puts you behind the 8 ball and all you have is to appeal. Which only stacks up in numbers and gives the bean counters the impression veterans are making a career out of appealing.

Jack Stagg one of the architects of the NVC said that in a hearing. Veterans make it their career to appeal to make more money. Well what Mr. Stagg DID NOT mention how many of those appeals were successful...like mine!!!!! The 5 year window he was referring to was my 5 year window of fighting all the way to Federal Court...where I won. So there was 2 appeals that did not have to happen in that 5 year window because the initial adjudicator was over their head in trying to understand my disease.

Don't bother looking up in the VAC directory for Jack Stagg he passed away about 5 years ago of cancer. And I make the following statement and until someone proves me wrong I will stand by what I say...

Jack Stagg made the veterans he labelled as trying to live off the government teet the ultimate pig at the trough. He had cancer and his doctors said you have less then 6 months to live. Instead of going home to be with his family he stayed on the job until he died.

So what you may say?

Well by staying on the job his families death benefits was over a million dollars whereas if he went home his death benefit would have been about a quarter of on the job death.

This is what we are up against.
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Re: Advice When Submitting a Claim

Post by Dove96 on Wed 02 Jul 2014, 13:47

Comment on wordiness.
We are required to answer questions if we say "No". I always answer on a separate sheet.
i.e.:
4. I am able to work in my regular occupation. No
I am slow at tasks, confuse easily and cannot concentrate. I volunteer at the local Museum two afternoons a week. My activities there verify the fact I cannot work an actual job. They are very forgiving.

Everyone is different. I try to keep it short. Sometimes I add a note of clarification if it adds some light on the subject. Even though the doctor said I shouldn't work this was more pertinent to me. Still I think I kept it short.

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Re: Advice When Submitting a Claim

Post by pinger on Wed 02 Jul 2014, 14:56

Dove...
Just my honest opinion and experiece. Stick with NO. Period. Common sense told me I should explain myself too. I was wrong.
Just stick with NO NO NO. It got me a better outcome. As Teen mentioned the adjudicators are not medically trained or specialists so why explain an ache or pain when they flat out discard renown specialists, mri's and cat scans? And until VRAB and their camp have truly armslength professional psychologists, forgo any emotional explaination or slant. You may feel the need to, but abbreviate it... i.e "Life in general sucks"
Do not become a broken wing, pun intended. pinger.
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Re: Advice When Submitting a Claim

Post by Dove96 on Wed 02 Jul 2014, 15:47

I have 8 claims stemming from one main condition. The other claims were consequential from multiple surgeries and related conditions.
Seven were successful. I had to appeal one.
I may have a broken wing but I can still fly.

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Help with vac application

Post by Newf on Wed 07 Jan 2015, 17:46

I am in process of making three applications; obstructive sleep apnea, tinnitus and hearing loss. Any suggestions on the best way to service connect these conditions? Or other tips or suggestions on filling out the application. I read the comments here and they are very helpful.
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Re: Advice When Submitting a Claim

Post by Newf on Wed 07 Jan 2015, 17:57

With my sleep apnea, I know my doctor is trying to link it to weight gain and lack of exercise equipment at various postings. However, I can see vac denying me because I CHOOSE to eat food and gain weight which causes sleep apnea. I am thinking I will have a better chance if I link the sleep apnea to being overworked, pain and sleep medication, stress and allergies. What r your thoughts or suggestions?
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Re: Advice When Submitting a Claim

Post by Sapper Zodiak on Thu 08 Jan 2015, 11:09

I suffer from extreme sleep apnea as well. No way to link it for me, as I have looked into the root causes thoroughly. Diet and exercise is key, but with a broken bod and chronic pain, its tough. Sisip has paid 100% for my c-pap machine though. If you are a client.
I cant imagine sleeping without it now. Good luck.
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Re: Advice When Submitting a Claim

Post by Teentitan on Thu 08 Jan 2015, 11:39

Newf have you had a sleep study done? Yes weight can be a problem with sleep apnea but not the cause.

A sleep study will show that you stop breathing during sleep, which happens to me, and VAC can't argue with that.

You were accepted to the RCMP with the condition so therefore VAC has to oblige and provide you with either a CPAP/BIPAP machine and renewal of consumable parts.

So do not apply with just your family doctor reporting it. Get a sleep study done at the nearest clinic/hospital.
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Re: Advice When Submitting a Claim

Post by Newf on Thu 08 Jan 2015, 15:05

Teentitan, I joined RCMP back in 1990's in perfect health at about 180lbs; no back pain, no allergies, no sleep apnea, etc. I developed allergies in 1997. Then I had two sleep studies completed; first in 2000 and the second in august of 2006; I had no signs of sleep apnea in both of these tests. At the time, my weight was 238lbs and I was working low stress job, no trauma, plain clothes, weekdays and 9-5pm shifts. I get transferred to isolated detachments working nights ,days, evenings, weekends, callouts to trauma (suicide, deaths, accidents) and high stress calls. I was required to wear my 30lbs of gear; duty belt, side arm, and vest. I was stressed with manpower shortages, lack of sleep, and back pain. In fact I lost about ten pounds. It go for a third sleep study in October of 2007 and I am diagnosed with severe sleep apnea with a body weight lower than the previous two tests. How much details should I articulate in the service connection part of the vac application? Should I list out all the reasons why I feel condition is service related; allergies, back pain, medication I was taking for pain and to help me sleep; lack of exercise facilities at this location, lack of down time, etc. and thanks for this great place to help and support each other.
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Re: Advice When Submitting a Claim

Post by Teentitan on Thu 08 Jan 2015, 15:54

I would emphasis the stress of the job for the sleep apnea.

If you can get a psychologist assessment about what the stress has caused it might help with the application as well. Not to mention confirm the back pain is real and not coming from your imagination.
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Re: Advice When Submitting a Claim

Post by Newf on Thu 08 Jan 2015, 16:39

Thank you!
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Re: Advice When Submitting a Claim

Post by Dove96 on Sun 15 Feb 2015, 09:41

"I get transferred to isolated detachments working nights ,days, evenings, weekends, callouts to trauma (suicide, deaths, accidents) and high stress calls. I was required to wear my 30lbs of gear; duty belt, side arm, and vest. I was stressed with manpower shortages, lack of sleep, and back pain. In fact I lost about ten pounds."
I agree with teentitan definitely seek a psychological assessment. Depression or PTSD may be a underlying factor.

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