KC’S MOST EXCELLENT WIN (#38)


VA Secret Handshake Award

VA Secret Handshake Award

As promised several weeks ago, here is KC’s win. He and I have been in touch for several years and soon discovered we’re nigh on to being related by marriage. His ancestral haunts are less than 20 miles from Casa Nod. He moved to West Virginia to work and find a VARO that is more equitable. In both respects, he succeeded beyond his wildest dreams.

Kel has been fighting VA off and on for as long or longer than even me which is unique. After attending the NOD Aspire Academy, he began his Odyssey in earnest. He had no idea how well the system works or, alternatively, how convincing he is with his evidence. Suffice it to say he was fluent enough to come away with what I consider one of the hardest ratings of all to attain-as well as the highest rating.

I have worked with many of you over the last five years and rarely, if ever, have any of you had the initial success I did in receiving a 100% rating for Hepatitis C right out of the gate. Kel is now the second recipient of this prestigious award. Many get sandbagged by VA late in the progress of their disease and VA purposefully drags in the Diagnostic Code for cirrhosis (7312). When this happens, as it did to Rob down in Salt Lick City, you end up in a netherworld stuck between HCV and the cirrhosis. Since many of the symptoms are duplicative, it is virtually impossible to advance to a meaningful (100%) rating without VA invoking the dreaded pyramiding regulation (38 CFR 4.14). Thus you end up    with 30% for cirrhosis:

Portal hypertension and splenomegaly, with weakness, anorexia, abdominal pain, malaise, and at least minor weight loss (DC 7312)

and 20% for the hep:

Daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period (DC 7354)

You could be sailing your sofa around the world daily with near constant debilitating symptoms and get no closer to the big banana because that would be “cheating”. Meanwhile, you are stuck in a special limbo trying to beg them to throw the cirrhosis rating on the ash heap and just focus on what caused the cirrhosis. Member Mark is now pursuing this conundrum. Imagine being so ill that you spend most of your waking hours with an upchuck bucket close at hand. Imagine VA insisting this is only worth 20%. Off to work Mark, and don’t forget to pack a barf bag with your lunch.

In my book I stressed this. Steer clear of any mention of cirrhosis. In Rob’s case they glommed onto it because there was such extensive discussion of it in his medical records. That’s pretty much what happens when you’ve had hep for 40 + years. VA graciously granted both ratings and then gleefully refused to give him a meaningful rating for either one.

Kel, on the other hand, carefully railroaded this onto the HCV siding and refused to let VA wander off subject. Granted, his condition has not graduated to the verge of decompensated cirrhosis yet, but the near constant debilitating symptoms are the signature hallmark of advanced, untreated disease. Kel was careful to emphasize this and induce his caregivers to say as much. In that regard, he wins early on and completely. He also garnered his Permanent and Total simultaneously and the kids will get their VA-financed college educations that come with Chapter 35 benefits.

Additionally, he skipped ahead a few chapters in my book and also graduated Magna Cum Laude by nailing down his Special Monthly Compensation “S” along with all the other accomplishments. I would say this was akin to a Cub Scout getting his Bear badge, a gold arrow point for his Wolf and a gold plus two silvers on the newly minted Bear.

One of my first projects in 2008 that carried over into my prolonged hospital stay was John Bisig (1958-2011). With some help, he advanced from 10% in 2008 to 280% following the same protracted hepatitis/cirrhosis quandary. He was able to get his civilian doctor to opine that the cirrhosis was secondary to the HCV which allowed VA to view the hep as the primary rating. Once that was accomplished he swiftly bumped up to the 100% and followed it with a trainload of secondaries leading to the huge rating. Unfortunately, he only lived several more years and was unable to reap the fruit of his labor. Of note, he did all this at the Houston VARO without having to appeal. That’s how well he dialed in on this process. I just channeled his energy in the right direction with pointers and advice. He, like Kel, was responsible for all the heavy lifting.

Kel now becomes the 38th recipient of the Win or Die Award for persistence.  As we are fond of doing here for your education, we publish Kel’s victory ( with his permission, of course) redacted to keep credit card fraud down to a dull roar. Unbeknownst to him, Cupcake and I will be putting a down payment on our new Mexican condo with his brand new American Express Platinum Card. We had no idea he had such a high credit rating. When we discovered this, we opted to upgrade from a one bedroom to two and get an ocean view instead of the mountains. A warm thank you is in order. We also purchased a Lifelock® policy in his name to protect him against fraud.

Attached here, in .PDF format, is his rating. While he didn’t get everything he wanted, I pointed out that is what the new, Form 21-0958 NOD is for. It keeps them hopping down at the RO and out of the bars. It’s a great read. The few. The proud. The persistent.

Decision2

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About asknod

VA claims blogger
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5 Responses to KC’S MOST EXCELLENT WIN (#38)

  1. Randy says:

    Congrats Kel. I too have appealed the process to have the HCV as a stand alone issue and asked the VA to do such, I think we all know who it was that caught their little trick. Anyhow I just wanted to congradulate you and hope to be posting some year of my own win for T&P.

  2. HCVet says:

    Way to go Kel and NOD…. Yes!

  3. Kel says:

    It certainly bears repeating… I couldn’t/wouldn’t have done it without you graciously sharing your vast knowledge of the maze we call the VBA c&p system. The amount of failed claims and lost appeals is directly proportionate to the amount of your books left unsold.

    • Kel says:

      I forgot to add that it also appears the folks here in the John Denver state of country roads don’t play silly games and do their jobs. What a very refreshing change from the Emerald City VARO of D-bags.

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