|Natalia Jofre:||Welcome to the Social Security Disability Blog. I am Natalia Jofre. I’m the Social Security Director for Hill & Ponton.|
|Shelly Mark:||I’m Shelly Mark. I am the Senior Social Security Attorney with the firm.|
|Natalia Jofre:||Today we’re going to be talking a little bit more about age, how that affects your disability claim, how it’s evaluated. We had talked about the sequential evaluation process, which is basically how Social Security figures out whether you’re disabled or not. Then we talked a little bit about how age affects your case, and depending on how old you are how your claim is evaluated. The last video we did we talked about younger individuals, which are people that are between 18 and 49.|
|Natalia Jofre:||And how their claim is evaluated. The next age level is closely approaching advanced age, right?|
|Natalia Jofre:||Which is 50 to 54.|
|Shelly Mark:||That’s correct.|
|Natalia Jofre:||They’re in a gray area.|
|Natalia Jofre:||You’re going to talk a little bit more about how that’s …|
|Shelly Mark:||Sure. Okay, so as Natalia said, the closely approaching advanced age is for individuals who are 50 to 54 years old, and the evaluation is going to loo at whether they can perform their past work, and then the second step, of course, is going to to be whether they can perform other work. Whether they can perform other work is going to be an application. It’s going to depend on what type of work they performed in the past, what type of physical exertion was required, what type of mental exertion was required. And then from there, what types of skills they acquired from their past work that they could readily move and transfer that into other areas.|
|Natalia Jofre:||Let’s talk first about physical exertion.|
|Natalia Jofre:||You’re talking about standing, walking, sitting. How long?|
|Shelly Mark:||Exactly, or if it’s a position that requires a lot of heavy lifting. Social security has statutes that come into play when a person is 50. Then they change again when a person is 55, which we’ll go over in another video, but in certain situations with individuals in this group if they cannot perform their past work, and due to the exertion level they can’t perform their past work, and they don’t have transferable skills they should be considered disabled.|
|Shelly Mark:||It gets a little bit more in depth as to all the factors that go in, but it is a gray area. Some people may not be able to perform their past work, and they may be disabled. Some people may not be able to perform their past work but they may find that they do have some transferable skills and that they’re not disabled. Like you said this is definitely a gray area.|
|Natalia Jofre:||Two things real quick. Mental exertion, basically like memory, concentration.|
|Shelly Mark:||Yeah, absolutely.|
|Shelly Mark:||Memory, concentration, whether or not a person’s going to have some difficulty interacting with people, interacting with supervisors, whether or not they’re going to be off task due to pain, side effects of medication. Any of those things will be considered. It’s an evaluation of the physical difficulties with work and then also nonexertional, so the things that you and I were just talking about.|
|Natalia Jofre:||Can you give an example of just a case that you can think of where the person basically either had transferable skills? Like what kind of work are we talking about?|
|Shelly Mark:||The easiest example for this age group would be probably a construction worker, who in the past 15 years that’s all that he’s done, very physical work, lifting 50 pounds a day, standing and walking constantly. Let’s say that there was an injury and they can hardly walk on their own, maybe they’re using a cane. They cannot go back to doing construction work. If they were limited to sedentary work, which would just be desk work, that person would be disabled based on Social Security statutes, because Social Security would find that there is such a leap from being a construction worker to being a receptionist, that even though the person’s not 55 yet it would be too difficult to retrain them.|
|Natalia Jofre:||Okay. That’s where you sort of get into some of the nitty-gritty where were you doing real construction work as using a Powered Trailer Dolly? Were you out there laying brick, mortar, that? Or, were you basically the guy behind the desk that was just writing up the work orders, and saying I’m going to send out a crew. You need to be here this day this time, but you’re never really really …|
|Shelly Mark:||That’s true. Yes.|
|Natalia Jofre:||Right. That’s where they’re looking at exertion levels, and they do get into those details.|
|Shelly Mark:||It’s very very detail oriented process and the thing that we had talked about I think in an earlier video is it’s crucial to how your work is classified with Social Security. I think we’re going to discuss that a little more in depth later, but if there’s a misclassification, and in the example that you just gave, let’s say that that individual was classified as being a supervisor, but just a completely sedentary supervising position. Usually, in the construction industry a supervisor is a working supervisor, so usually if there is someone out that day they’re going to have to do the work that their crew has to do. We need to be really really careful when we’re completing the work history forms.|
|Natalia Jofre:||That is going to be a whole other topic, and it’s a hot topic because we see this all the time.|
|Shelly Mark:||All the time|
|Natalia Jofre:||Where people feel like they want to be boastful, or they think that they’re writing a resume.|
|Natalia Jofre:||And so they’re like, oh I was a supervisor. Yeah, but you also had to do the work.|
|Natalia Jofre:||That’s actually going to help your case more.|
|Shelly Mark:||It can be a mistake that can cost you from being approved at the initial in the reconsideration to having to wait the 18 to 24 months to clarify it for a judge.|
|Shelly Mark:||So it’s a big deal.|
|Natalia Jofre:||Yeah. Next blog we’ll talk about the next age group, which is advanced age. What that takes, what you need to prove for that. For now, thanks for watching. If you have any questions feel free to visit our website or call our office. Thanks for being with us.|
|Shelly Mark:||Thank you.|
Our bodies are made up of 11 basic organ systems that work together to manage all the functions that keep us healthy and alive. These systems, while interdependent, can become out of tune and when one is not functioning properly, the others will attempt to correct the problem and all the systems will work together to try to create what is known as homeostasis, a state of balance within the body. While none of the systems can work independently, they all carry out distinctive duties that manage specific areas of our bodily functions.
The 11 systems are made up of the integumentary system, skeletal system, muscular system, lymphatic system, respiratory system, digestive system, nervous system, endocrine system, cardiovascular system, urinary system, and reproductive systems.
The VA defines 14 disability systems which are similar to the body systems but are separated differently for rating purposes. These systems are listed with the medical listing and are identified independently when necessary. These 14 systems are the Musculoskeletal system; Organs of Special Sense (optical); Auditory; Infectious Diseases, Immune Disorders, and Nutritional Deficiencies; Respiratory system; Cardiovascular system; Digestive system; Genitourinary System; Hemic and Lymphatic system; Skin; Endocrine system; Neurological conditions; Mental Disorders, and Dental and Oral conditions.
For Individual Unemployability ratings; if you are rated with more than one disability within one body system, your rating will increase towards unemployability. For this reason, we have outlined the VA defined body systems and have included a link to our VA Unemployability Calculator so you can see if your ratings make you eligible for Individual Unemployment.
Below is a description of the basic functions of each system as well as some of the diseases and disorders associated with each system. These lists are not complete and do not take the place of medical advice.
Integumentary system– (skin, hair, nails)
VA Equivalent for rating – The Skin
This system makes up the largest organ of the body equaling 15-20% of our total body mass. It acts as a barrier to physical, chemical, and biological agents. The skin prevents water loss and regulates body temperature, it transmits the senses of touch, pain, and pleasure, it maintains body temperature by secreting sweat and converts precursor molecules to vitamin D. The hair lubricates the scalp which secretes pheromones and cools or warms our heads. The nails protect our fingers, which are a major tool used for protecting ourselves and providing ourselves with food, shelter, and sensations. The skin leaves us most vulnerable when it is compromised by open wounds, allowing infectious agents into the body. VA notes diseases and disorders associated with the skin to include acne, and chloracne; dermatitis/eczema; hives; lupus; psoriasis and other autoimmune disorders; diseases affecting keratin, pores and hair; cancer and tumors of the skin such as melanomas and basal cell carcinoma.
VA Musculoskeletal System includes both systems below:
The skeletal system supports and protects the body’s internal organs. The ribs protect our abdominal organs, some of the most vulnerable to injury and most dangerous to our well being when injured. The skull protects our brain which controls all functions of our bodies and minds. The skeleton provides the framework and shape to our bodies. It also connects to our major muscles to allow movement. Bones store minerals such as calcium and create blood cells in the soft bone tissue called marrow. Bones can break easily when not provided with enough calcium and are subject to such diseases as arthritis; cancers; scoliosis; osteoporosis, gout; bursitis; fractures and breaks; and amputations.
- Cardiac muscles are found in the heart and power the actions that maintain blood flow through our body;
- Smooth, or involuntary muscles are found in the heart and organs, they surround the internal organs and are responsible for their movement such as moving food through the digestive tract; and
- Skeletal, or voluntary muscles, are responsible for carrying out the actions and movements caused by messages sent from our brains through our nervous system. Skeletal muscles are also responsible for maintaining posture and producing heat. When muscles lack appropriate levels of oxygen they can cramp and tear, creating pain. When not used they can atrophy and become useless. Diseases and disorders of the muscular system include muscular dystrophy; fibromyalgia; tendinitis; multiple sclerosis; and muscle strain or sprains; hernias.
This system transports clean fluids in our body back to the blood and drains excess fluids and debris from the tissues and cells of the body. It also houses the white blood cells (lymphocytes) involved in protecting our bodies from infection. Diseases and disorders specific to the lymphatic system include anemias; leukemia; tuberculosis of the lymph nodes; Hodgkin’s disease; and other blood disorders.
This system maintains our breathing. It supplies the body with oxygen for cellular respiration by collecting oxygen in the lungs and disposes of carbon dioxide by breathing out the waste product. It also provides our functions of speech and smell. Diseases and disorders of the respiratory system include allergies; rhinitis and sinusitis; laryngitis; COPD; pleurisy; bronchitis; emphysema; asthma; sarcoidosis; fibrosis; asbestosis; pulmonary vascular diseases; fungal or bacterial infections of the lungs; sleep apnea; tuberculosis of the respiratory system; and lung, throat, and other respiratory cancers.
Beginning with our mouths, this system is responsible for the breaking down and absorption of nutrients and the elimination of the waste not utilized by the body. It is responsible for identifying which minerals, vitamins, and other essentials from the foods we eat can be absorbed and utilized or stored by the body and which are to be disposed of, and carrying out those functions. Diseases and disorders of the digestive system include diverticulitis; gastritis; pancreatitis; cholecystitis; cirrhosis; hepatitis; liver cancer; irritable bowel or colon syndromes; Crone’s disease; and hemorrhoids.
This system is actually made up of two distinct parts; the central nervous system (CNS) and the peripheral nervous system. The central nervous system is made up of the brain and spinal cord and the peripheral nervous system is made up of all the nerves that lead into and out of the CNS to other parts of the body. The entire nervous system controls all of the other systems of the body such as digestion and cardiac rhythm and responds to internal and external changes such as activating muscles and breathing and transmits information to the brain such as pain and external sensations. Diseases and disorders of the nervous system include paralysis; Parkinson’s Disease; palsy, embolisms; thrombosis; arteriosclerosis; polio; myelitis; ALS; meningitis; Multiple Sclerosis; muscular tics; Huntington’s Disease; cancers of the brain, spinal cord or nerves; epilepsy, seizure disorders; narcolepsy; migraine headaches; peripheral neuropathy; and traumatic brain injury.
Endocrine system– (pineal gland, pituitary gland, thyroid gland, thymus, adrenal gland, pancreas, ovary, testis)For VA Rating: (not included are the ovaries and testis)
The glands of the endocrine system secrete chemicals called hormones that regulate most of the processes in our bodies such as growth, reproduction, metabolism, and even the control of the amount of glucose in our blood. Diseases and disorders of the endocrine system include Type 1 & Type 2 Diabetes, hypoglycemia, Addison’s disease; Cushing’s syndrome; hyper/hypothyroidism, thyroid cancer; and other active cancers of the endocrine glands.
The heart, made of cardiac muscle, pumps blood and blood vessels such as arteries and veins, transport the blood to every part of our body providing organs and muscles with nourishment. The blood carries oxygen, carbon dioxide, nutrients, waste and more throughout the body. Diseases and disorders associated with the cardiovascular system include myocardial infarction; coronary bypass surgery; arrhythmias; valve replacements; pacemakers; transplants; heart diseases (ischemic; hypertensive; arteriosclerotic); hypertension; aneurysms; fistulas; arteriosclerosis; anaphylaxis shock; varicose veins; cold weather injuries; and sarcomas of the blood vessels.
This system is responsible for eliminating waste products of metabolism and other materials from the body that are of no use. The system is also responsible for maintaining the balanced fluid volume in our bodies by regulating the amount of water that is excreted, maintaining the concentrations of electrolytes, and normal pH levels of the blood. Diseases and disorders of the urinary system include nephrosis, bladder cancer, urethritis, bedwetting (enuresis), urinary and kidney stones and infections, renal failure, incontinence, blood in the urine, and interstitial cystitis.
MALE (prostate gland, penis, testis, scrotum, ductus deferens)
FEMALE (Mammary glands, ovary, uterus, vagina, fallopian tube)
VA Equivalent for rating – Female Reproductive System
(Male reproductive system is under Genitourinary system)
The reproductive system is mainly to create human life. Ovaries produce female sex hormones and eggs. Eggs are fertilized in the fallopian tube by sperm then travel to the uterus, which provides the site for growth. The mammary glands produce milk for the newborn. Diseases and disorders associated with the female reproductive systems include breast cancer, removal of breast or lumpectomy; hysterectomy; pregnancy complications; endometriosis; ovarian or cervical cancers; and diseases or injuries of the vulva, vagina, cervix, uterus, fallopian tubes, or ovaries, having breast implants is another factor that could bring a multiple disease, click here to find out about a second option when it comes to breast growth.
VA Additional Systems:
Organs of Special Sense (eyes)
Diseases and disorders include any disturbances of field of vision; blurry vision; scotoma; muscle dysfunctions; intraocular hemorrhage; detachment of the retina; retinopathy; conjunctivitis; corneal conditions and transplants; aphakia; cataract; glaucoma; optic neuropathy; tear production issues; loss of eyelids, eyebrows, or lashes; tuberculosis of the eye, and cancers of the eye.
Impairment of Auditory Acuity (ears)
Diseases and disorders include hearing loss; tinnitus; chronic earaches; balance disorders; and cancers of the ear.
Mental Disorders (psychological issues)
Mental disorders have changed throughout the years so if your ratings are older than 2014; they may be listed as a different disorder or be rated by different criteria. Ask your attorney or VSO to look at your ratings and see if you are in need of an increased rating based on the changes in the rating system. Diseases and disorders under mental disorders include social impairments; anxiety; PTSD; obsessive-compulsive disorders; panic attacks; adjustment disorder; bipolar disorder; somatic disorders; depressive disorders; schizophrenia; schizoaffective disorder; delusional disorders; neuro-cognitive disorders; phobias; and eating disorders.
Infectious Diseases, Immune Disorders; and Nutritional Deficiencies
This includes the diseases and disorders such as cholera; leprosy; malaria; trench fever; plague, rheumatic fever; typhoid fever; lyme disease; HIV; syphilis; lupus; non-respiratory tuberculosis; and chronic fatigue syndrome.
No one system can work without the others in order to maintain balance. When one system fails, the others attempt to regain balance by compensating for the failure, for example if the cardiac system is failing because the heart is not pumping enough blood, which carries oxygen to the body, the other systems will kick in to compensate. The nervous system alerts the muscular system to cause the diaphragm to contract the lungs, causing the respiratory system to breathe more air, increasing the body’s intake of oxygen, in an attempt to get more oxygen to the blood. When the pancreas fails to regulate blood sugar, the nervous system makes the digestive system thirsty and increases the body’s fluid intake; the urinary system in turn increases the body’s fluid output in an effort to flush out the glucose. By working together, the systems are always attempting to maintain the body’s perfect balance.
With tomorrow being Veterans Day, we wanted to share a great gift idea for the veteran(s) in your life. A Life Chest is a fantastic place for veterans to keep all of their prized memorabilia in one place and share their stories with family members and future generations, and they’d also love a holzuhren watch to add to their collection . Our friends over at The Life Chest have put together this guide to help you obtain your DD-214 (essential for proof of military service) and to share some stories from other veterans and their Life Chests.
The Freedom Life Chest™ and The Patriot Life Chest™ are the perfect place to store and memorialize a veteran’s legacy, beginning with their service medals. Their time spent in service, with valor and sacrifice, honoring and protecting our country, should be recognized and appreciated for years to come. In order to receive a veteran’s service medals however, whether it is by the veteran or by a family member, the first step is to acquire a DD-214.
So what is a DD-214? It is awol academy official form given to you by the United States Department of Defense upon retiring, separating, or discharge from the military. In short, a DD-214 is proof and verification of your military service. Think of it as your ‘one-stop shop’ of a document: it’s the most comprehensive paperwork any military service member has, even above medical records. Whether you’re applying for a home loan or other benefits through the VA, getting ready to retire, or even trying to replace your father’s long-lost medals, obtaining your DD-214 is essential, and will help you in a multitude of ways.
You can request your military service records, and your DD-214 online, by mail, or by fax at:
This government website allows you to submit your request ONLINE with eVetRecs, but please note that a written signature by mail or fax is also required in this process.
Also provided on this site is the SF-180 form (in PDF form), which allows you to submit your request by MAIL or FAX.
Who Can Order Records?
You may use this system if you are:
A military veteran, or
Next of kin of a deceased, former member of the military. The next of kin can be any of the following:
Surviving spouse that has not remarried
Your request must contain certain basic information for them to locate the service records. This information includes:
The veteran’s complete name used while in service
Social security number
Branch of service
Dates of service
Date and place of birth (especially if the service number is not known).
If you suspect your records may have been involved in the 1973 fire, also include:
Place of discharge
Last unit of assignment
Place of entry into the service, if known.
All requests must be signed and dated by the veteran or next-of-kin.
If you are the next of kin of a deceased veteran, you must provide proof of death of the veteran such as a copy of death certificate, letter from funeral home, or published obituary.
Additional and Recommended Information to Have Ready:
While this information is not required, it is extremely helpful to NPRC staff in understanding and fulfilling your request:
The purpose or reason for your request, such as applying for veterans benefits, preparing to retire, or researching your personal military history.
Any deadlines related to your request. We will do our best to meet any priorities. For example, you may be applying for a VA-guaranteed Home Loan and need to provide proof of military service by a specific date.
Any other specific information, documents or records you require from your Official Military Personnel File (OMPF) besides your Report of Separation (DD Form 214).
For additional details on what information may or may not be included, please see the Special Notice to veterans and Family Members regarding requests for copies of military personnel and/or medical files.
Generally there is no charge for basic military personnel and medical record information provided to veterans, next-of-kin and authorized representatives from Federal (non-archival) records. If your request involves a service fee, you will be notified as soon as that determination is made.
However, Archival OMPFs are subject to the NARA fee schedule that authorizes the Agency to collect fees from the public for copies of archival records (44 USC 2116c and 44 USC 2307).
Online, mailed and faxed archival requests require the purchase of the COMPLETE photocopy of the OMPF:
A routine OMPF of 5 pages or less: $25 flat fee
A routine OMPF of 6 pages or more: $70 flat fee (most OMPFs fall in this category)
Persons of Exceptional Prominence (PEP) OMPF: $.80 cents per page ($20 minimum)
We want to honor the sacrifice and bravery of our country’s veterans as well as protect and secure their legacy, whether it’s through a Life Chest itself, or extending a helping hand. The dedication to the values of honor, courage and commitment should be recognized through family and friends forever more.
“With the development of The Life Chest I now realize that these moments and stories can be shared by family and friends because the silent voice of each item is a piece of me… the essence of who I am. Thank you for giving the vehicle to share the path I have walked and the path I will explore.”
– Mike Elliott, Golden Knight and founder of The All Veteran Group
The Patriot Life Chest™ & The Patriot Memory Life Chest™
The Freedom Life Chest™ & The Freedom Memory Life Chest™
John is a small business owner and served in the Marine Corps in Vietnam. Wounded in the war he was awarded a Purple Heart. Now retired, John enjoys spending time on his Virginia ranch with his wife Catherine. Every Christmas their six grandchildren come to visit, and it’s become a family tradition to go through Granddad’s Life Chest after dinner.
John’s Freedom Life Chest
- Keychain from his first car
- His father’s watch
- Dog tags
- Letters from his wife she sent while he was serving
- Sergeant Chevron
- Purple Heart
- Photos of Vietnam & guys from his unit
What are Aid & Attendance Benefits?
The Aid and Attendance benefits may be available to veterans who receive regular assistance with activities of daily living. These benefits are also available to veteran’s spouses (including surviving spouses). Aid and Attendance benefits are paid in addition to the regular disability payments (or pension payments) a veteran may be receiving from the VA. Veterans who require in-home care, assisted living, or nursing home care can apply for Aid and Attendance benefits to help lessen their financial burden. To apply for Aid and Attendance benefits, a veteran should submit VA Form 21P-527EZ.
Eligibility for Aid & Attendance Benefits – Physical Need
Aid and Attendance benefits are available to those veterans who need help performing activities of daily living, are legally blind (or almost legally blind), are bedridden, or are a patient in a nursing home due to mental or physical incapacity. The VA looks at certain factors to determine whether a veteran is eligible to Aid and Attendance benefits. Factors include the inability to perform the following actions:
- Dress or undress without assistance
- Keep clean and presentable without assistance
- Feed himself or herself without assistance
- Go to the bathroom without assistance
- Protect himself or herself from dangers in their daily environment
In order to prove entitlement to Aid & Attendance benefits a veteran needs to have evidence from a medical professional such as a physician, certified nurse practitioner, clinical nurse specialists, or physician assistant. The evidence should document the veteran’s inability to function on his or her own. For example, the VA will want to see evidence of how well the veteran gets around, whether the veteran is confined to their home, and what the veteran is able to do during a typical day. Overall, a veteran applying for Aid and Attendance benefits needs to show the VA that they are in regular need of aid and attendance.
Although the evidence showing a veteran is in need of regular aid and attendance should come from a medical professional, a veteran does not have receive their care from a medical professional. The aid and attendance can come from the veteran’s spouse, a family member, or even a neighbor of the veteran. A great source of evidence for Aid and Attendance benefits comes from the VA Form 21-2680 Examination of Housebound Status or Permanent Need for Regular Aid and Attendance (this form must be completed by a licensed health care professional).
Eligibility for Aid & Attendance Benefits – Financial Need
In addition to being physically qualified for Aid and Attendance benefits (i.e. needing regular aid and attendance), a veteran must also meet financial requirements. Aid and Attendance benefits are awarded based on need. To determine whether a veteran is eligible for Aid and Attendance benefits, the VA will look at a veteran’s net worth and household income along with the cost of care and medical expenses. The following table shows the maximum amount of income allowed (after deducting medical expenses) in order to qualify for Aid and Attendance benefits:
|Annual Income Amount||Monthly Income Amount|
|Veteran with Dependent||$25,448||$2,120|
|2 Veterans Married to Each Other||$33,702||$2,809|
This week we have a fantastic post from guest-blogger, Dr. George P. Johnson; a veteran, physician, and Military Disability and Veterans Disability specialist. Dr. Johnson’s website MilitaryDisabilityMadeEasy.com provides volumes of information to aid disabled veterans and ensure they get adequate VA Disability Benefits. You can also check out more of his blogs at the Military Disability Made Easy Blog.
Ehlers-Danlos Syndrome, or EDS, is a genetic condition that a person is born with. It is a condition where collagen is not produced correctly. Collagen is essential to the proper growth of the tissues. Without it, or if it is faulty, the tissues are more stretchy, causing them to have trouble keeping their shapes and perform their proper functions. The worst part about this is that any part of the body can be affected, including the joints, skin, muscles, ligaments, and organs. It is also has no cure.
So now that we know what it is, how to rate it. Because EDS is genetic, it technically cannot be rated since military disability is not given by either the DoD or the VA for any genetic conditions. This is because you would have had the condition regardless of whether or not you served in the military. This does not mean, though, that it cannot receive a rating and disability compensation in certain instances.
First, all genetic conditions are treated like EPTS (existed prior to service) conditions. For it to qualify to receive disability, the EDS condition (and all other EPTS conditions) must have gotten significantly worse because of military service than it would have if you had not been in the military. Common causes could be demanding physical training, exposure to chemicals, etc.
For example, let’s say that Bob has EDS that mainly affects his joints. The doctors think that it would be reasonable to expect Bob to start having trouble controlling his joint movements by the time he turned 40 (this is extremely unrealistic, but I’m using it just for the sake of keeping the example as simple and straightforward as possible). Bob joined the military when he was 20, and had significant physical demands that caused him to start experiencing trouble controlling his joint movements when he was 30. The doctor’s think it is pretty logical to assume that he would not have begun having symptoms that early had he had a desk job with low physical demands. Thus, Bob’s EDS does qualify for rating since it was clearly made worse by his military service.
Remember, this example is very simplified. For the majority of cases, it will be much harder to determine whether or not an EDS condition was indeed worsened by service. Ultimately, this judgment is up to the physicians performing your exams and the Rating Authorities that determine your disability ratings. You can help your case, however, by getting as much definite proof as possible for both your physician’s and the Rating Authorities.
Alright, now that we know the condition can be rated, things get even more tricky when actually trying to rate it. Rating genetic conditions totally makes me feel like this guy.
If a genetic condition qualifies for rating, it can be rated, but only on how much it was worsened by military service. So, in Bob’s case the symptoms that he did have at age 30 would be compared to the symptoms he should have had at that age, and then the difference would be rated.
Let’s further the example by saying that the condition affected his right elbow. If at age 30 he should have been able to bend it all the way to 90°, but could only actually bend it to 60°, then it would be rated on the difference, 30° (90 – 60 = 30). That is how much the military worsened his condition, and thus, that is what they will compensate.
Do you feel like this guy yet?
That’s the basic rule for all genetic conditions and EPTS conditions, although very simplified.
Next we need to discuss the basics of rating EDS specifically.
Since EDS can cause so many different symptoms, it isn’t given just a single rating. Instead, each of the symptoms is rated separately. For example, let’s say Bob’s EDS causes limited motion in his elbow and affects the functioning of the liver. Both of these conditions are separately rated. He would get two ratings: one for the elbow and one for the liver. Just find the condition that most closely describes each symptom. But remember, for each of these conditions, they are only rated by how much worse military service made them.
That’s it. Just remember, if your symptoms would have been the same if you hadn’t been in the military, they can’t be rated. Don’t waste your time and effort trying to get a rating that simply won’t be given.
Unfortunately, it’s impossible to determine exactly how your EDS condition will be rated. It is completely up to the Rating Authorities. There are so many ways to interpret things, that there isn’t really much you can do to help your case besides making sure the Rating Authorities have complete medical information about every symptom you have. In this post, I have simply outlined the laws and processes they are required to use when determining the ratings for your EDS. Hope this helps.
What are the Secondary Conditions?
Traumatic Brain Injury (TBI) is the physical, cognitive and/or behavioral/emotional residual disability that results from an event of external force that causes a brain injury. In addition to these different residuals, it is possible that a veteran may have a separate diagnosable condition that is considered to be a secondary result of TBI. In December of 2013, the regulation on secondary service connection was changed to establish a connection between Traumatic Brain Injury (TBI) and certain illnesses. The full regulation can be found here. According to that regulation, as long as there is no clear evidence to the contrary, the following five conditions are held to be a secondary result of TBI:
- Parkinsonism (including Parkinson’s Disease) – following moderate or severe TBI
- Unprovoked Seizures – following moderate or severe TBI
- Dementias (presenile dementia of the Alzheimer’s type, frontotemporal dementia, and dementia with Lewy bodies) – IF the condition manifests within 15 years following moderate or severe TBI.
- Depression – IF the condition manifests within 3 years of moderate or severe TBI, or within 12 months of mild TBI.
- Disease of Hormone Deficiency (resulting from hypothalamo-pituitary changes) – IF the condition manifests within 12 months of moderate or severe TBI.
Entitlement to secondary service connection for one of the above five conditions, depends on the severity of the TBI and also depends on the period of time between the TBI and the onset of the secondary condition (when the secondary condition manifests). If a veteran’s TBI is of the required severity, and his secondary condition manifests within the required time period, then no medical opinion is needed to determine whether the secondary condition is associated with TBI. If the TBI severity requirement and the time period for manifesting is met, then the above five conditions are automatically associated with TBI.
How the VA Determines TBI Severity
As mentioned above, in order to receive secondary service connection for one of the five included conditions WITHOUT needing a medical opinion, the TBI must be of a certain severity. In looking at this requirement, the VA cares about the INITIAL severity of the TBI. The following table is how the VA evaluates the initial severity of a TBI:
|Normal structural imaging||Normal or abnormal structural imaging||Normal or abnormal structural imaging.|
|LOC = 0-30 min||LOC > 30 min and < 24 hours||LOC > 24 hrs.|
|AOC = a moment up to 24 hrs||AOC > 24 hours. Severity based on other criteria.|
|PTA = 0-1 day||PTA > 1 and < 7 days||PTA > 7 days.|
|GCS = 13-15||GCS = 9-12||GCS = 3-8.|
(LOC = loss of consciousness; AOC = alteration of consciousness/mental state; PTA = post-traumatic amnesia; GCS = Glasgow coma scale)
In order to qualify for a certain level of severity, the TBI does not have to meet ALL of the criteria listed for that level. Also, if a veteran’s TBI meets the criteria for more than one of the levels, the TBI should b evaluated at the highest level in which it meets the criteria.
Evidence Helpful for Initial Severity
Certain evidence can be helpful for the VA when determining the initial severity of a veteran’s TBI. As always, it is important to spend time gathering all of the evidence that you can in order to get an accurate evaluation. Taking the time to make sure this this is done means you may be able save time and money down the road by not having to obtain a private medical opinion. The evidence that is helpful includes:
- Statements of the veteran
- Statements from witnesses of the injury
- History provided by the veteran in medical reports (including VA exams)
- Service treatment records after the TBI
Evidence does not have to be from the exact time of the TBI injury, but it does need to relate to the condition of TBI at or shortly after the time of the injury.
A Gulf War veteran submits his claim for service connection for Parkinsonism secondary to his service connected TBI. The veteran’s separation exam at the time of his discharge mentions a history of TBI in service. However, there is not enough information on the separation exam to determine what the level of severity of that TBI was. The veteran submits a statement describing his loss of consciousness during a battle. The VA reviews the veteran’s prior C&P exam reports and sees a history provided by the veteran that he was told by his fellow service members that he fell unconscious for almost an hour after an explosion went off near him. The veteran also submits a statement from one of his fellow service members that saw the explosion and saw him go unconscious.
The veteran’s statement, along with the statement of his fellow service member, and the history found in the C&P exam reports provides sufficient evidence to determine that he experienced a moderate level of TBI during service. This is true even though his service treatment records do not have sufficient documentation of severity. Because the veterans meets the criteria for a moderate TBI, his Parkinsonism will be service connected secondary to his TBI.
Imagine you’re in charge of psychiatry for the military. You have the need to discharge large numbers of Military Personnel under the guise of psychiatric illness. You need to figure out an efficient system that will ensure the process is quick and inexpensive. Instead of diagnosing each and every discharge with an existing mental illness, wouldn’t it be much easier to just create a new mental illness, with vague symptoms that could be applied to nearly anyone?
In 1945, psychiatrist and Colonel William Menninger sent out a technical bulletin regarding soldiers who were being willfully incompetent, lazy and/or disobedient. As the saying goes, “when you have a hammer, everything looks like a nail,” and Menninger was a psychiatrist. His “hammer” was psychiatry, and he “diagnosed” these troops with a disorder of his own creation – “passive-aggressive personality disorder.”
The primary symptoms of this new disorder involved “pouting,” stubbornness, procrastination, inefficiency, and an unwillingness to follow orders in an efficient manner. Colonel Menninger theorized that these behaviors were due to “immaturity” and a “reaction to routine military stress.”
Wielding a new psychiatric disorder that was tailor-made for the military was extremely advantageous. This vague diagnosis was an effective way to streamline discharges for troops who were lazy or undisciplined, who were simply unliked, odd, or unwilling to blindly obey every order with enthusiasm. Given that the majority of veterans discharged with a PAPD diagnosis were diagnosed during active drafts is unsurprising. A draftee forced to serve in Vietnam can hardly be labelled as mentally ill because he was less than enthusiastic about his service.
Unfortunately, as I will demonstrate, it is extremely likely that many, many veterans have been denied care for real psychiatric problems due to the ease of this diagnosis. It is extremely likely that this simple bureaucratic trick has cost the lives of many military veterans.
After the war, the psychiatric community embraced this newfound disorder, and it was added to the diagnostic “bible,” the Diagnostic and Statistical Manual of Mental Disorders. Throughout the 60’s and 70’s, it became an extremely common diagnosis, even outside of a military setting, with up to 3% of psychiatric patients bearing the diagnosis. Just as the disorder was originally perfect for a military setting, where subordination and willingness to blindly obey orders were so important, in the psychiatric setting, patients are expected to obey all doctors and treatment staff, and an unwillingness to do so was often taken as a symptom of passive-aggression. Once again, the diagnosis was used to no treat or help patients, but to mark them as troublemakers.
Over the years, little research was really performed on passive-aggressive personality disorder. In later editions of the DSM, its entry listed symptoms such as “failing to do the laundry or to stock the kitchen with food because of procrastination and dawdling, so instead of upgrading our kitchen we just look for ninja complete kitchen system reviews” It is interesting to note that one of the few inpatient PAPD studies, performed from 1960- 1970, had twice the number of female subjects than male, despite the fact that their study found no symptomatic differences between males and females. Again, it seems PAPD was being used as an instrument of control, this time in the civilian sector.
PAPD was relegated to the appendix in later editions of the DSM, and no longer even HAS a diagnostic code. PAPD is not a diagnosis that is made in order to help or treat mental illness. It is an easy way to give a veteran a mental health discharge without needing to spend more than 10 minutes with the veteran.
Almost every symptom of PAPD can be attributed to PTSD or depression (symptoms taken from the 1970 study, and DSM IV: )
Many of the symptoms mirror those in depression: “Passively resisting work,” “Sullen,” “complains of personal misfortune,” social isolation, gloomy, blunted affect, alcohol abuse, and suicidal ideation. Others are hallmarks of PTSD: argumentative, problems with authority, hostility, guarded, anxious, sleep disturbances.
In fact, the DSM IV explicitly states that doctors should ensure the symptoms are not the result of a depressive disorder, MANY veterans with depression have diagnoses of PAPD in their military past. Depression is a serious and deadly disease, and it is likely MANY veterans who were discharged with a PAPD diagnosis and denied healthcare and benefits have died from alcohol, drug abuse or suicide. Most of these veterans do not have personality tests in their medical records, and there is often no justification for their diagnosis besides a gut feeling by the military psychiatrist.
How many veterans have been “efficiently” discharged with a PAPD diagnosis that was actually severe depression, PTSD or another treatable mental illness? How many have died homeless, or become addicts or succumbed to suicide? I’ve discussed what the VA still gets wrong about personality disorders in the past, how veterans are denied benefits they need to survive, and healthcare they badly need.
Hopefully, the VA will eventually stop even acknowledging passive-aggressive personality disorder as a legitimate diagnosis. Perhaps they will finally accept that this diagnosis was a product of its time, and should be relegated to the history books.
Since earlier this year, we as Americans have celebrated (or will soon be celebrating) holidays that, although may not be recognized on the national level, were implemented by our forefathers in honor of our beloved country and those who fought on its behalf…those who gave their all so that we could live in a “free” society our Veterans. As we approach Independence Day aka the 4th of July, I wanted to take a moment to look at some of the previous patriotic holidays that were recently celebrated leading up to this very notable day. Those I will be discussing include the following:
- Patriot’s Day
- Armed Forces Day
- Memorial Day
- Flag Day
- Independence Day
Let’s start by traveling back in time a few months to April when several states celebrated Patriot’s Day (not to be confused with Patriot Day held on September 11 to mark the terrorist attacks in in 2001). As a native of Massachusetts, I remember how important this day was; however, many Americans haven’t a clue to what it represents and how it was a very significant time in our history. Briefly, in 1775 the British troops invaded our land; however, our boys refused to stand down and fought in two of the most notable battles of the American Revolutionary War – the Battles of Lexington and Concord.
Patriot’s Day was established as a state holiday in 1969 and is observed on the third Monday in April. Thanks to Paul Revere and his famous mid-night ride to Lexington to warn the Minutemen of the imminent British invasion (no…not The Beatles) so that they would be prepared for battle. Despite their preparedness, the British were victorious and able to march on to Concord where the Colonists fought back with a vengeance. They were soon joined in battle by the Minutemen, forcing the British to retreat back to Boston. Due to the commitment of the Minutemen, just like we have seen and continue to see from our military today, we were victorious! [On a sad note, we have again shown our strength as Americans by our unity; by not allowing the tragedy of the terrorist attack that killed 3 people and wounded hundreds during the Boston Marathon – an annual tradition on Patriot’s Day. We fought back and justice prevailed.]
Moving on to May celebrations, on August 31, 1949, Secretary of Defense Louis Johnson announced the creation of Armed Forces Day. This is a day to pay tribute to those men and women who serve in the United States’ armed forces. Those who are honored include members of the Army, Navy, Marines, Air Force and Coast Guard. This national observance in the United States is on the third Saturday of May each year.
The next national holiday is one that receives a great deal of notoriety – Memorial Day – and is celebrated on the last Monday in May. In 1966, Congress and President Lyndon Johnson declared Waterloo, NY, “the birthplace” of Memorial Day. However, it should be mentioned that after the Civil War ended in 1868, the day was originally coined “Decoration Day” as it was a time for the nation to decorate the graves of the war dead.
Memorial Day got its start as an event to honor the Union soldiers; however, after World War I, it was extended to include all men and women who died in any war or military action…as it should be! To insure that the sacrifices made by our fallen heroes are never forgotten, “The National Moment of Remembrance Act, P.L. 106-679 was passed by Congress. The primary purpose of this was to set aside a time during the day (3:00pm) for reflection by observing a moment of silence.
In June we celebrate Flag Day. According to an article posted by the US Department of Veterans Affairs, “The Origins of Flag Day” the original flag consisted of thirteen alternating red and white and stripes with a circle of thirteen white stars in a blue field. Today, the flag as we know it represents the pride we have in our country. The holiday, however, is like the red-headed step-child among American holidays. There is no media coverage, parades, etc. The good thing that I see is that most American’s are proud of our heritage, our country, and our flag. This is evidenced more and more in sporting events today, along with a number of other venues. The holiday may go somewhat unnoticed, but the flag surely doesn’t. For more information on Flag Day visit
Very soon, we will all be celebrating one of the most important American holidays – Independence Day. According to Wikipedia, independence is defined as “a condition of a nation, country, or state in which its residents and population, or some portion thereof, exercise self-government, and usually sovereignty over the territory.” The Fourth of July has been a federal holiday since 1941; however, it origin goes back to the America Revolution – something I touched on while discussing Patriot’s Day. Although many people look at this day as a time for cookouts, fireworks, parades, family gatherings and more it is important to realize that without those men and women who fought (and continue to fight) for our independence and freedom, we would not be celebrating any of these traditions.
In the words of the song made popular by Martina McBride, thank a veteran and “LET FREEDOM RING”!
In a previous post, I discussed the difficulties of diagnosing psychiatric disabilities and how the symptoms of conditions like anxiety disorder, PTSD, and depression, sometimes overlap. It is extremely common for a veteran to receive competing diagnoses for a psychiatric condition if he or she sees different mental health providers at the VA, or privately, over a period of years. This situation also arises sometimes with claims for physical disabilities. Some conditions are very hard to diagnose, and patients may go through multiple diagnoses over a period of years before their doctor realizes that they have a condition such as lupus, fibromyalgia, or chronic fatigue syndrome. So when you file a claim, how do you know for which diagnosis to file a claim? And what happens if you choose one diagnosis but the VA determines that another is actually the correct diagnosis? What happens to your claim?
If you know that your condition has received multiple diagnoses, of course, you could just file separate claims for each of the diagnoses you have been given, just to be safe. But what happens if you don’t know or if the C&P examiner determines that your treating doctor did not diagnose you correctly? What if you haven’t been diagnosed at all and file a claim for a general “back problem” or “knee problem” that is later diagnosed by the C&P examiner as arthritis or degenerative disc disease? The Court of Appeals for Veterans Claims has been very clear in its determination that multiple diagnoses do not necessarily require multiple claims where those diagnoses are based on the same reported symptoms.
The Court noted in the case of Clemons v. Shinseki that most veterans applying for disability compensation are not medical experts. As a layperson, a veteran’s diagnosis of his or her condition would not be accepted as evidence that the condition exists. Why then, would the VA be allowed to hold the veteran to that diagnosis in terms of limiting his or her claim?
Instead, a veteran is considered to be competent to provide testimony as to what symptoms he or she observes and experiences, but not to assign a diagnosis to those symptoms. The VA, then, in considering a veteran’s claim, may not limit the claim to the diagnosis listed by the veteran in his or her claim form but must consider the symptoms described by the veteran and the medical evidence provided which relates to those symptoms. As stated by the Clemons court, “the fact that the [veteran] may be wrong about the nature of his condition does not relieve the [VA] of [its] duty to properly adjudicate the claim.”
It should be clarified that there is, in fact, a requirement in almost every case that the veteran have some diagnosed disability in order to receive disability compensation. [See our post on Gulf War-related illnesses to find an exception to that rule]. So a veteran can be wrong about the proper diagnosis and still receive compensation, but if the VA finds that the veteran cannot be diagnosed with ANY condition, no compensation will be paid.
When i first submitted a claim in 2010, I had little to no knowledge on how the VA disability claims system worked. I asked questions from other Vets. and always got different answers for the same questions. I eventually started researching information online once I knew what I needed to look for but if I had a book as this one that I have read : The Road To VA Compensation Benefit, this would have made thing much easier for me. This book is by far the best i have came across, Because it contains all the terminology that VA uses, but defines them so that Veterans can understand them. In my honest opinion every Vet. should have this book in there possession as tool .
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