CAVC– FAUST V. WEST–A FAUSTIAN BARGAIN

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I have been receiving quite a bit of mail regarding VA reducing some of your ratings out there on the fruited plain. It seems that in spite of the major backlog in claims, VA has taken it upon themselves (and found time) to give a haircut to some of you legally. Don’t feel pregnant and alone. They did it to me, too. It was more of a bait and switch and I even alerted them to the fact that they were rating me under the wrong criteria. I had no idea they’d do a “Our Lady of Lourdes” remission game on me and say my scars had miraculously resolved.

The primary reason I write of this is that it shines a new light on what is useful to prove you are entitled to TDIU, or any rating for that matter, based solely on financial records rather than medical ones.

First, let’s talk about this mishap Mr. Paul L. Faust found himself in. Paul was a bit player in the Vietnam War. He bent his brain as many did and finally got around to filing for it. He eventually worked his way up the ratings ladder and got to the top tier. At some point, as is common with many of us (me included), he alienated his wife and their marriage disintegrated.

The Paulster also discovered how vindictive wives can be. She filed all her evidence of  finances and a goodly portion of his when she asked for apportionment of his comp. check. To the uninitiated, this is like alimony. You make X dollars on VA comp. If you split the sheets, the newly minted ex- can ask for her own check to be sent directly to her for dependency and the rugrats. Since those records are sealed, Paul couldn’t see them and was fenced out. She spilled the beans that he was pulling down a lot more George Washington coupons than one would expect to on TDIU. Paul didn’t think this one through. If you want to claim 100% bent brain or even Total Disability, you have to hide the evidence if you’re out there pulling down $48 K a year. Granted, that’s a bitch to stuff under the mattress in cash but if VA discovers you’re featherbedding them, you’ll get a tremendous haircut. I suppose Paul’s recent significant other didn’t think that one through either. She was whittling down her own potential settlement in the process. All is fair in love and divorce. At one point in 1997, she realized she was cutting her own throat and asked to withdraw the request for apportionment. Unfortunately, the financial cat was out of the bag now and running free at the VARO. They aren’t brain dead down there and saw what was going on. Paul’s rating immediately suffered “shrinkage” back down to 70% because his work earnings were almost on a par with his VA comp.

The long and the short of this seminal decision was that the BVA and the VARO usedfinancial records rather than medical records to reduce Paul’s rating. Makes perfect sense. Now here is where it benefits you the Veteran in jurisprudence. Say you have a long, old claim and you finally win it. You now will get what VA calls a Fenderson rating. It may be characterized in VAspeak as a staged or retrospective rating. At any rate, the VA will attempt to reconstruct your history of your illness with anything at hand medically. They will studiously avoid resorting to your financial records unless you point them to this and use it in your defense. The usual scenario plays out like this. You filed in 1994 and they see your medical records show you were ratable for 10% for hammer toe. They’ll continue this until 2008 when you have the foot amputated for cancer because it was misdiagnosed in 1994 originally. So, you get no increases in the interim. Perhaps you only saw the doctor sporadically over the years and never complained about the increasing severity and progression of your toe disease. It happens. Many guys soldier on and watch the thing rot off. They don’t complain until it gets green and stinky.

I had progressively worse Hepatitis and Porphyria.  I let the the HCV get green and stinky until 2006. I kept up on the Porphyria and have a good record of a gazillion gallons of bad blood pumped out and tossed in the trashcan. VA can point to my lack of medical records to support a decision to award me little or nothing in the interim when conducting this exercise in forensic claims research. What they cannot ignore is a financial history evidenced by my Social Security earnings statement that clearly revealed my income dropping precipitously over those same 20 years due to the progression of the disease.

Additionally, when you are in a “sheltered” work environment such as self -employment, your wages are artificially increased or decreased due to it being a family affair. If the sums earned are not commensurate with the norm for other like-employed wage earners, then your employment can’t be classified as “substantially gainful employment”. Paul Faust made this mistake. He claimed he was pulling down $58 K before he filed and was only bringing in about $30K since he became more bent. When the ex-Mrs. Faust, now Ms. Johnson, filed for apportionment, he was back up in the $48 K range. Paul neglected to inform VA of his good fortune, too. Bad Paul.

Ultimately, Mr. Faust’s ratings demise was predicated more on his financial improvement than any medical improvement in his brain box. He had used the financial argument to argue for a higher PTSD ratings percentage in the first place and this was used against him by the BVA. Turnabout is fair play with the VA and was perfectly legal here. It certainly doesn’t help when the ex is sandbagging you on top of it, though.

So, to sum it all up, if you are skinny on medical records when you get to the Fenderson dance, always remember that  the SSI records are a valuable font of legal rebuttal as to what your health was causing your finances to do- i.e. plummet. Here’s the legal ramifications from the decision:

Similarly, 38 C.F.R.  § 3.343(c)(2) requires that when “a veteran with a total disability rating for compensation purposes based on individual unemployability begins to engage in a substantially gainful occupation during the period beginning after January 1, 1985, the veteran’s rating may not be reduced solely on the basis of having secured and followed such substantially gainful occupation unless    the veteran maintains the occupation for a period of 12 consecutive months.” 38 C.F.R.  § 3.343(c)(2) (emphasis added). When read together, then, as to a post-January 1, 1985, reduction of a 100% rating based on individual unemployability, subparagraphs (1) and (2) of  § 3.343(c) mandate that (1) a 100% rating may be reduced only when “clear and convincing evidence” shows the veteran’s “actual employability” for a position that constitutes a “substantially gainful occupation”, and (2) such reduction may not be made based solely on the veteran’s having “secured and followed such substantially gainful occupation unless the veteran maintains the occupation for a period of 12 consecutive months” (disregarding any “temporary interruptions in employment which are of short duration”).  38 C.F.R. § 3.343(c)(1), (2).

In order to determine whether in this case there is clear and convincing evidence under  § 3.343(c)(1) that the veteran was actually employable at a substantially gainful occupation, we must define the term “substantially gainful occupation”. Section § 3.343 itself does not define the term. However, paragraph (c) of  § 3.343 applies only when there has been an underlying award of a total rating “based on individual employability”, i.e., based on § 4.16. Hence, we look to § 4.16 for a definition of a “substantially gainful occupation” under § 3.343(c); that regulation provides in paragraph (a) that “marginal employment shall not be considered substantially gainful employment”, and that “marginal employment generally shall be deemed to exist when a veteran’s earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person.” 38 C.F.R.  § 4.16(a). (Neither paragraph (b) nor former paragraph (c) of   4.16 contains any information pertinent to an inquiry as to the meaning of the terms “employability” or “substantially gainful occupation” under § 3.343 as applied to TDIU rating-reduction cases.)

 Although § 4.16(a) does not define specifically what substantially gainful employment is, it does provide that “marginal employment” is not substantially gainful employment and thus implies that employment that is more than marginal may be considered to be “substantially gainful employment”. In Moore (Robert) v. Derwinski, the Court recognized the need for a clear definition of unemployability but was, at that time, “not yet prepared to impose a Court-created rule on the BVA”.  Moore (Robert),   1 Vet. App. 356, 359 (1991); see also id. at 358 (stating that, for the purposes of § 4.16(a), “substantially gainful employment . . . . suggests a living wage”); Beaty v. Brown,   6 Vet. App. 532, 538 (1994) (citing Moore (Robert)). Nevertheless, in Moore (Robert), supra, we “suggested to the Secretary that there is much that could be borrowed from [opinions of other federal courts regarding] . . . whether a social security disability claimant is able to engage in a ‘substantial gainful activity’”. Cf.  Ferraro v. Derwinski,   1 Vet. App. 326, 332-33 (1991) (discussing possible definitions of substantially gainful employment including nonmarginal employment but concluding that disposing of that case did “not require that we adopt a definition of ‘substantially gainful employment’”). In view of the fact that the Secretary has yet to issue a clear definition of substantially gainful employment, despite the Court’s encouragement to that effect provided in Moore (Robert) almost a decade ago, today we articulate such a definition for the purpose of dealing with the facts of this case.

 We first consider the “amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person”.  38 C.F.R.  § 4.16(a). According to current statistics provided by the U.S. Department of Commerce, Bureau of the Census, the poverty threshold for one person under the age of 65 in 1993, at the time when the veteran was first assigned a 100% rating, was $ 7,518/year. See U.S. Department of Commerce, Bureau of the Census, Current Population Survey, Poverty Thresholds: 1999 (last modified Jan. 27, 2000). In this case, although the veteran had been earning only $ 675/year in 1991 (R. at 456), evidence submitted following the August 1993 RO decision showed him earning $ 48,000 in 1993 (R. at 504-40, 554) and $ 36,000 in 1994 (R. at 622, 657), well in excess of the poverty threshold for one person. Hence, the veteran was at least not marginally employedIn addition, we note that a determination whether a person is capable of engaging in a substantially gainful occupation must consider both that person’s abilities and his employment history. See Gleicher v. Derwinski,   2 Vet. App. 26, 28 (1991). In this case, the veteran has been employed in the same occupation since at least 1987, albeit that he is making less money now than he did then. R. at 456-57 (veteran’s April 1993 sworn testimony that in 1987 he had earned $ 52,000 and in 1994 he had earned $ 36,000). {13 Vet. App. 356} Moreover, we find appropriate guidance in — albeit that we are not bound by — the definition of “substantially gainful activity” provided in regulations promulgated by the Social Security Administration (SSA). See Murincsak v. Derwinski,   2 Vet. App. 363, 370-71 (1992) (comparing the use of terms “substantially” and “gainful” contained in VA regulations with the use of the same terms in SSA regulations); Moore (Robert), supra (suggesting that Secretary refer to SSA caselaw for definition of unemployability); cf.  Beaty,   6 Vet. App. at 538 (noting that VA cannot “in certain cases choose to apply SSA regulations that have never been adopted by the Secretary [of Veterans Affairs] as applicable to VA claims adjudication” while “not adopting certain [other] SSA regulations that would generally be beneficial to a claimant”). Under SSA regulations, “substantially gainful activity” is defined as “work that — (a) involves doing significant productive physical or mental duties; and (b) is done . . . for pay or profit.” 20 C.F.R. § 404.1509 (1999). On this record, the exact nature of the veteran’s day-to-day work activities is unclear; however, it is not disputed that he runs his own business managing pension investments. R. at 842. He is responsible for hiring employees (ibid.) and meets individually at least four times per year with each of his “20 investment clients” (R. at 843). In the context of the entire SSA regulatory concept of “substantially gainful activity”, it appears that the fact that a person believes that he should be earning “$ 100,000″ and that he is not able to work a 40-hour workweek (R. at 660-61) would not render him incapable of engaging in substantially gainful activity, because those SSA regulations clearly provide that “work may be substantial even if it is done on a part-time basis or if [a claimant is] . . . paid less,  or [is given] . . . less responsibility than when [the same claimant] worked before.” 20 C.F.R.§ 404.1572(a) (1999).

In view of  § 4.16(a) and of the guidance set forth in the Court’s precedents and drawing a helpful but not binding or determinative analogy from the full context of the SSA regulations discussed above, the Court holds that where, as in this case, the veteran became employed, as shown by clear and convincing evidence, at a substantially gainful occupation — i.e., one that provides annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the veteran actually works and without regard to the veteran’s earned annual income prior to his having been awarded a 100% rating based on individual unemployability — such employment constitutes, as a matter of law, a substantially gainful occupation and thus “actual employability” for the purposes of 38 C.F.R.  § 3.343(c)(1). See Murincsak, Gleicher, Moore (Robert), and Ferraro, all supra.

As to the requirement under § 3.343(c)(2) that the veteran have “maintained” such substantially gainful occupation “for a period of 12 consecutive months” (disregarding any “temporary interruptions in employment which are of short duration”), the veteran has testified under oath that he has been selling insurance and investments since 1985, and appears to have done so without any significant interruption since at least 1991. R. at 456. There is no indication that he has, in the twelve months prior to the effective date of his reduced rating, experienced any interruption in his employment, nor does he argue to this Court that any such interruptions have occurred.

Hence, the Court holds, as a matter of law, that even if  § 3.343(c) applies to this veteran (that is, because the veteran’s 100% rating may have been based in part on individual unemployability and also in part on the severity of his rated condition), the evidence overwhelmingly shows that that regulation, just as was the case with  § 3.343(a), affords him no protection for his 100% rating. Therefore, the Board’s failure to provide an adequate discussion of § 3.343(c) could not have been prejudicial to this appellant. See 38 U.S.C.  § 7261(b); {13 Vet. App. 357} Edenfield and Soyini, both supra; see also Wilson (Merritte), Brown (Kevin), and Fugere, all supra.

The decision in no way impedes a reading in the obverse. Thus an argument, perfectly plausible, can put forth the proposition that the VA need look no further than your SSI earnings report to ascertain whether you were engaged in substantially gainful employment or marginally employed and earning little or nothing.

The decision is wrapped up in some strange programming format. Every attempt to convert it defies me. Therefore I pasted it to a word doc and converted it to .PDF below.

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

There’s more than one way to skin a cat or the VA.

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VARO–ST. CHARLES, MISSOURI

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Member Joe Average Vet is on the road like Charles Kuralt looking for a good VA news story. While staying at the Ameristar Casino in St. Charles, Mo. yesterday, he happened on this (above) in the lobby.

VA is a slippery outfit. Caught with their pants down one too many times in Orlando, they are now resorting to small casinos in out of the way places like this. At $169 a pop for the cheapest room, I wonder if they break a sweat when they think about all those poor homeless Vets that are out back dumpster-diving for dinner.

QBRs. What does that stand for. Questions on Benefits Rejections? Perhaps a seminar on how to phrase denials in politically correct vernacular? I called Ameristar and was connected with the Convention Booking desk. Vanessa was very helpful but must have had the vapors because she was not apprised of what it might stand for. Her reply was ” Well, gosh. That’s a durn good question but it’s way above my pay grade, y’know?”

VARO ST. CHARLES

images (3)GAMBLING FOR ANSWERS 

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VARO– JANESVILLE, WISCONSIN

va Janesville

Here we thought there were only 58 Regional Offices where claims were processed. As old Doc Emmett Brown in Back to the Future might have said post-VBMS, “Where we’re going, you don’t need any VAROs”.

I recently filed with the Seattle Regional Office for my cryoglobulinemia and fibromyalgia. Recently is back in August 2012. I’m beginning to think like a VA employee and characterize time  subjectively.  At any rate, I filed. VA has been a buttwipe and refuses to recognize I am housebound in fact. They want 160% before they’ll give it to me. So be it. I’m at 146% now so a few more 10%s and 20%s will take me over the top. All this time and energy wasted on what is a no brainer annoys me. The SMC-S rule is dispositive. If you’re chained to the house and the water closet, you’re housebound. They feel that’s what Depends undergarments were designed for. Their favorite argument is always “Well, if you’re so friggin’ housebound, how come you still manage to make it to your appointments at the VAMC?” Gee, my daughter? My wife? Immaculate Transportation. DAV? They don’t have much of an imagination other than to say 100% does not equal 160%. Neither does 146%. End of claim.

Of more interest is what arrived in the mail last week. VA is now gathering evidence. This is the next phase after being put on hold for a year when you file a claim. The letter instructed me to “send it in”.  I have already given them the Gutenberg Bible on it but I opted to do it all over. My C-file runs to seven volumes and takes up a whole file cabinet. What’s another 130 pages?

The instructions in the letter were to send it all to an address in Janesville, Wisconsin 53547. A quick parsing with Google© Earth reveals the above-a small industrial park with lots of low, one-story buildings, presumably not equipped with smoke detectors or sprinkler systems in the event of a fire.

As if this wasn’t odd, member Randy who is filing for secondaries in Denver tells me his claim has been farmed out to Janesville. Can it be we are seeing a new phenomenon? Perhaps they have subcontractors doing our claims in out of the way places. Are they VA employees? Are the records secure? Is Janesville just a fig newton of the imagination like Farmville? Do they do virtual claims there? All these queshuns an’ no answers. Hey, maybe the NSA infiltrated Google and merely substituted these images of Janesville to personally fake me and other Veterans out.

To get to the bottom of all this, I fired up the Google Go anywhere magic carpet ride. Going down to street level, we see the new “VARO” on the right of the picture adjacent to Foster Avenue. What is touted as a VARO looks suspiciously like an unsecured storage area with eight foot roll-up doors. I will always maintain I am not a conspiracy freak but this is a bonafide enigma.

VA

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REGIONAL OFFICES PLAYING “NOT IT”

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Unknown soldier whose records were burned up in
July 12th, 1973 NPRC Fire in St. Louis, Mo.

In what is proving to be a public relations disaster at the VA, an attempt to clean out the two-year backlog of claims has just uncovered even more, older ones. Eunice Robuck Clapper of  Sadieville, Kentucky was cleaning out her attic when she discovered what appeared to be old DVA claims forms filed by the American Red Cross (ARC) for VA Burial Benefits for her great grandfather on her father’s side.  The forms, dated in late November 1865, asked for Burial benefits and a widow’s pension for her great grandmother Beatrice  Robuck.   The claim is in the name of Pvt. John Robuck, Company G, 70th Ohio Regiment (Cavalry), mistakenly identified as an 11B Infantryman  who was killed August 21st, 1865 on the Ohio River in a freak accident aboard the Union steamer  U.S.S. Argosy (Number 3).

Sgt. John Robuck's remains in Rono, Indiana

Sgt. John Robuck’s remains in Rono, Indiana

Nine of his fellow cavalrymen also perished when the ship was blown ashore during a storm. The boilers overheated and blew up, killing the troops and their mounts instantly. The irony was that the war was over and the men were returning home to their loved ones and preparing to separate from service. Apparently they were buried on shore where they fell by local farmers. Repeated attempts by the ARC over the years failed to obtain any resolution to the claims. VA officials had indicated it had been “deferred” several times awaiting more information but would never comment on why it had not made a decision over the one hundred-plus years during the pendency of the claims.

VA spokesman Vince Cully today revealed the cause of the delay in adjudication. Apparently there was as fire in July 1973 at the National Personnel Records Center in Saint Louis, Missouri and the records were destroyed before a decision could be rendered. Mr. Cully also confirmed that VA rating technicians had done their homework on this one. “We even went back and determined that their spouses had also passed away in the intervening century and a half . Thus, we were sadly unable to award the burial benefits or Dependents Indemnity Compensation (DIC) due them. Since the benefits accrue only in the name of the spouse, the ancestors were and are not entitled to any funds. Unfortunately, they did not appeal within the allotted one year period anyway and the claims are now final. We regret that.”

When queried on how a “deferral” on a claim could somehow turn into a denial requiring an appeal, Mr. Cully indicated he was late for his tee time and promised he would get back to us at a later time with a detailed SOC explanation.

Repeated entreaties over the years to the NPRC divulged that the other nine cavalrymen’s records had also inexplicably been warehoused in the same building with  Pvt. Robuck’s. No one was able to satisfactorily explain why “Unknown”‘s C-file was included in these as they have another warehouse devoted exclusively to records of that type. Shaniqua Townsend, a NPRC employee, commented that ” All the Air Cav records are kept in there. I sure don’ know why the unknowns’d be there too. Not my building anyway.”

Ancestors of the nine identified troopers maintain they have advocated for years to have the soldiers’ remains reinterred in a recognized Veterans Cemetery with proper burial and honors. Buzz Clampett (no relation to Jed) had this to say last week: ” We’ve asked and begged and pleaded with them fellers both up in Indinaplis and ovah in Louahville to move them folks and they jes’ point the finger at each other. I take the wife down a coupla times every summer to put flowers on Grampa Fiscus’ grave and let her weed whack the grass and poison ivy down while I hold her beer. That shore is a beautiful piece of country out that way.”

Others we spoke to point to the Dayton, Ohio Regional Office as being the problem. The cavalrymen were Ohioans insist both the Indianapolis and Louisville Regional Veterans Service Center Managers, so the onus of responsibility for their remains lies with Dayton.

The nine known servicemen, all of the 7oth Ohio, were identified as:

John A Behrens, Commissary Sergeant (F&S)

Albert Rader, Private

John Robuck,  Private

Martin V. B. Long, Private First Class

Hugh K Taylor, Sergeant

George W. McKinley, Specialist 1st Class

John McDaniel, Private First Class

Aaron Fiscus, Corporal

Amos Rose, Private

Officials at the U.S. Army Central Identification Laboratory in Hawaii as well as the Dover Annex indicated to our reporter that no requests had come in for forensic workups of any graves in Indiana since the War of Northern Aggression. This seems to conflict with reports from the Regional Offices that attempts to identify maternal DNA in the unknown soldier’s remains had been undertaken as early as 1920 with nothing ever definitively determined. The Army spokesman expressed frank disbelief that any identification via mitochondrial, or even maternal DNA could have occurred prior to 2002. “They’re talking through the top of their hat if they told you that” said Major Tom, spokesman for the Army’s CILHI. “That’s simply fiction. What do you reckon them VA folks are smoking back there in Dayton?” he added.

We’ll stay on this and keep you up to speed on what we discover. A moment of silence is due. Delay. Deny. Even after we die.

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We contacted the Ohio congressman whose district encompasses Dayton to see if we could elicit a response as to why the soldier’s remains had not been properly interred. A spokesperson for Congressman Jerry Mander’s office indicated he was investigating this and would have a press release soon.

This report was filed on site by our correspondent Cupcake from the actual scene of the 1865 accident in Magnet (formerly known as Rono), Indiana. The Ohio River is in the background.

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WEDNESDAY DOUBLE HEADER IN DC

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With all the focus on Vets for the first time since the War of Northern Aggression (1861-65), we are starting to see a grateful America shower us with some of its accolades. This is heartwarming for Vietnam Veterans who, due to prior commitments, almost to a man  missed their  “Welcome home” ticker tape parades. A word to Veterans supporters. The phrase “Welcome home” grates on the ears of many Vietnam Vets. You may just hear the rejoinder “Really? Where the hell were you when I arrived back at San Francisco in 1972?” We forgive those who weren’t born yet but people need to understand that there is still a bit of animosity associated with that one. 

Welcome home back

On the brighter side, we have two pieces of good news. Member Randy of the mile-high club in Colorado (this has nothing to do with pot) decided he was a bit “miffed” about the summary courts martial on his ILP request and rightfully so. He got nowhere with it. In perspective, he filed his Form 21-1900 and got the standard dog and pony show. Then they decided there was absolutely nothing they could do for him. Nary a high-shelf can grabber or a grab bar for the shower. Seems ol’ Randy was flush and set for life in the lap of luxury. Apparently, Vets realize that when they hit the 100% lottery they are flush. $3 k ± a month plus SSD? Dude, you are rich. Ignore the fact that you are still an eighth of an inch above the poverty level and your shelf life sticker is screaming “done”. So Randy took electronic pen in hand and dropped a bottle into the IRIS ocean. More importantly, he dropped another in the Potomac River and it washed up in front of-ta-daaaa!- the Casa Blanca at 1600 Pennsylvania Ave. NW. Randy reports instant success. It seems his “new” Vocational Rehabilitation Officer has decided to revisit their previous assessment and have a new pow wow. He will be having a tête à tête (beer summit?) at the end of the month and we’ll all be praying for his success on the Tempur pedic bed request. Nothing like a little Congressional/Presidential Interest on ILP.

starbucks-old-logo

Our second story is pure gold. Another of our fellow Veterans, Ralph (not his real name) came over from Hadit.com and asked for advice on back issues. He writes to say he was forced to catch up with Dr. Craig Bash between flights at the airport in Washington, D.C. Seems the VA wants to renege on his old ratings and zero him out. As an aside, I wish to express that I am shocked. Shocked-do you hear me? In addition, they’re trying to move him from DC 5003 to 5002 in spite of diagnosed osteoarthritis. Apparently, he is one of  that extremely small minority who visited the Our Lady Of Lourdes Shrine and received the miracle of remission of his arthritis. Oddly, he disremembers traveling to Spain. Ralph even denies he possesses a passport. Immaculate Conception we are familiar with. Faith healing? I’m iffy on that but Immaculate Transportation?  You  can almost hear Jed Clampett saying “Yewwwwwwwww-doggies!”

In spite of this lack of proof of travel, VA still opted to reduce and switch. He was able to connect with the eminent nexus letter writer for a personal examination to quash the objections of VA that an examination of this sort could not be accomplished long distance via Skype or by records review. Here’s the kicker. Dr. Bash was en route to another city and agreed to see Ralph at the airport. Ralph flew in and they connected there. Starbucks, with a minimum of fuss, permitted them to pull two tables together in their airport outlet and allow Dr. Bash to do an exam on his back. I can imagine the nexus letter. ” The examination was conducted in my Washington, D.C. offices on June 29th. The findings were…” Is that a kick in the butt or what? I suggest you all visit Starbucks’ Facepage and thank them profusely for their gracious treatment of Veterans and for accommodating Dr. Bash and Ralphie. Only in America, nodsters. Only in America.

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Veterans Administration’s 0%
Shrine to Remission and Healing

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The list of Health Insurance Marketplace links by state

Suppose you use the VHA for all your health care needs but want to price and perhaps add a private health insurance plan for extra security.  Perhaps you want to be able to consult with a particular specialist.  Or worry that you might break or shatter your ankle somewhere far from a VA facility.  If you go to a private hospital’s ER, and the VA doesn’t consider your problem a true EMERGENCY, they won’t pick up the tab.  

Depending on your income and other factors, your premium for dual coverage may be affordable in 2014 when ACA is implemented.

If you live in these states, go to :https://www.healthcare.gov/

Alabama

Alaska
Arizona
Arkansas
Delaware
Florida
Georgia
Illlinois
Indiana
Iowa
Kansas
Louisiana
Maine
Michigan
Mississippi
Missouri
Montana
Nebraska
New Hampshire
New Jersey
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
West Virginia
Wisconsin
Wyoming

These states have their own websites so go here if you live in:

California: http://www.coveredca.com/
Colorado: http://www.connectforhealthco.com/
Connecticut: http://www.accesshealthct.com/
District of Columbia: http://hbx.dc.gov/
Hawaii: http://www.hawaiihealthconnector.com/
Kentucky: http://kynect.ky.gov/
Maryland: http://www.marylandhealthconnection.gov/
Massachuetts: https://www.mahealthconnector.org/portal/site/connector
Minnesota: http://mn.gov/hix/
Nevada: http://exchange.nv.gov/
New Mexico: http://www.nmhia.com/
New York: http://healthbenefitexchange.ny.gov/
Oregon: http://coveroregon.com/
Vermont: http://healthconnect.vermont.gov/
Washington: http://www.wahealthplanfinder.org/

The laggard states are Idaho and Rhode Island:

Idaho: http://gov.idaho.gov/priorities/Exchange.html

Rhode Island:  http://www.governor.ri.gov/healthcare/message/

If you live in a territory, you can’t buy in the HIXs.

Emergency room costs are exorbitant.  These experiences are worth reading about: http://www.nytimes.com/2010/08/07/health/07patients.html?_r=2&

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WE DON’T NEED NO STINKIN’ CARBONITE

LawBob Squarepants shares this exciting development with us. 

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BUT HE COULD BE A TERRORIST

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If you could just step over here and remove your legs…

 This just in from rotorhead Mac. Just because an American soldier gets an arm or leg blown off doesn’t mean he’s not a potential terrorist waiting to get even with America. Or so it would seem. Retired Marine Corporal Nathan Kemnitz obviously fills the bill as one of those just dying to even the score with the U.S. Well, he’s hiding behind his dress uniform and using it for subterfuge. Right?

Let’s get serious, ladies and gentlemen. Rules are for the “majority” of the cases. Then common sense enters in. If he has a DEERS card, chances are he didn’t manufacture it and it isn’t fraudulent. If he’s wearing a Purple Heart, chances are he isn’t trying to get a better seat on the plane using the Stolen Valor ploy. Hiding bombs under or among the medals is virtually inconceivable. Similarly, of all the people in America, he is the last I would suspect of ulterior motives. By his actions he has demonstrated that he has an equal or greater love for both country and family. No ifs, ands or buts. Some of us are above suspicion regardless of what the TSA feels is an appropriate response.

At some point after 2001, common sense flew out the window and escaped. It’s about time for the pendulum to swing back in the other direction. Erring on the side of caution is admirable. Erring on the side of stupidity and regulations is unconscionable. One size does not fit all. Had this been  Governor Chris Christie, I wager they would have let all 340 lbs. of him ooze on through with nary a glance.

I recently traveled back to the East and went through the full body scanners. I wear an abdominal support courtesy of abominable VA surgical practices. In a word, it corrals my 9 errant ventral hernias and holds me together. The TSA spotted it on their scope and went into high dudgeon. I will say they took a different tack after I explained  the purpose and medical necessity. I no longer felt the TSA guy was trying to get to second base with me. They were extremely cordial afterwards and swabbed my hands for explosives residue. I was prepared for a strip search. I got the same treatment on my return in Louisville. There is a polite way to do this and the idiot’s delight method. Corporal Kemnitz got the bum’s rush and he was in uniform. That’s bogus and indefensible-even in a politically exact world.

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Does tinnitus interfere with your ability to get to sleep…?

………eeeeeeeeeeeee……..

Tinnitus has been a health problem for my DH since Vietnam.  To keep from going bonkers, he developed the typical DIY techniques of creating white noise with fans, the TV, and radio.   Getting to sleep can be a trial when you hear a noise that never stops.  Fans and air-conditioning noise helps in the summer but in the winter a mini-fan has had to suffice.  

Today, while at the VA, he requested a VA-issued sound generator because he’s tired of dealing with this alone when there are professionals to help him.  Good news!  He’s going to get one in two weeks!  

A visit to one VA website  links to Walmart, Sharper Image and others where veterans can buy their own “tinnitus-distracting” devices.  Stop the bus.  Why are they promoting these corporations when a veteran may be eligible for a “sound generator” through their VA auditory clinic?

SOUND GENERATORS. These devices provide white noise or a
narrowband noise to mask or cover up an individual’s tinnitus (ringing or
buzzing in the ears). They are especially helpful for patients who have
difficulty sleeping as a result of tinnitus.

Other assistive listening devices (ALDs) available  include an amplified telephone and television systems–which is a great idea if your housemates are always telling you to “turn it down”.    My DH does have an amplified telephone on loan courtesy of the State of MN deafness program.  He has a VA-issued hearing aid.

So, shoot a “secure message” to your VA audiologist or call the clinic and ask for a device prescription.  It just might help.   If you have experience with VA services for the hard of hearing , please share it on ASKNOD so we can all benefit.

Tinnitus is frustrating, not curable, but manageable.  Hearing loss is socially isolating so do protect the hearing you still have.

Posted in Guest authors, Tips and Tricks, Vietnam Disease Issues | Tagged , , , , , , , , , , | 3 Comments

KY VARO– COL. SANDERS’ WIDOW LOSES ON DIC AGAIN

Colonel Sanders at Democratic National Convention

In what Veterans Administration historians say is the longest case on record, the widow of  Harland D. Sanders, a colonel in the Kentucky  National Guard, lost again for the third time in her bid to obtain DIC benefits.  The claim is certifiably antique in VA terms and has been continuously prosecuted since his death in 1980. True to their promise to eradicate all claims older than two years, VA officials “certainly stepped up to the plate” on this one as  VA Under Secretary for Extraordinarily Rapid Claims Resolution  Allison  “Wonderland” Hickey put it. 

As some may recall, Col. Sanders divorced his wife of 69 years, Eunice,  in 1978. In what has graciously been described in the immediate family as a “winter/spring marriage”,  he wed his fourteen year old, fourth cousin once-removed, Dixie. Col. Sanders passed several years later of congestive heart failure and Ischemic Heart disease. Dixie has maintained to this day it was due to his service to our great nation and claimed she finally had the service medical records called STRs to prove it this time.

Mrs. Sanders and her attorneys have adroitly kept the claim alive and it has been appealed and remanded numerous times to the Court of Appeals for Veterans Claims and even twice to the Federal Circuit Court of Appeals. In an effort to utilize the latest technology, her legal sleuths opted to use the the Disability Benefits Questionnaires, the online filing, and Ebenefits in order to submit a Fully Developed Claim. WLRO Channel 5 News reporters, their camera crew, and VA officials at the Louisville, Kentucky VA Regional Office were standing by to receive it when it came through the doors.  In what is reputed to be the wave of the future at the VA, they were able to rule on it in minutes.

Harland-Sanders-12353545-1-402

Harland David Sanders
1890-1980
Colonel, Kentucky National Guard

The rapid resolution now sends the claim back into limbo. A VA official who wished to remain nameless at the Louisville RO said it would be several more years before it was certified and docketed at the Board of  Veterans Appeals in Washington, D.C. He wouldn’t comment on the merits of the claim but was overheard to say “He had more cooking oil than blood in him at his autopsy.  That dog won’t hunt.” Our AskNod correspondent, John Rambo, took that to mean Dixie didn’t have an ice cube’s chance in Hell of winning this claim.

Colonel Sanders was service connected for a back claim at 60 % as well as for tinnitus and hammer toe. The combined ratings entitled him to Total Disability due to Individual Employment (TDIU). He had claimed his employment in a sheltered work environment did not constitute meaningful employment but VA continued to deny his claims. Apparently he had a claim pending with the VA that had been filed by his Veterans Service Organization at the time of his demise. VA regulations permitted Dixie to file in his stead for his benefits. Veterans of Foreign Wars spokesman Bud “short round” Wiser  is proud of their initial work and claims that the battle isn’t over. At the ceremony at the VFW bar after the denial, Mrs. Sanders presented Mr. Wiser with a check for $10,000 to help defray the cost of  the champagne,  hors d’oeuvres and beautiful ice sculpture of Col. Sanders’ likeness.

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