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Matthew Hill

Video Blog – Buddy Statements for Service Connection

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Matthew Hill: Hello, I’m Matthew Hill here with Carol Ponton, on the Hill & Ponton VA Video Blog. It’s a day we’re talking to you about buddy statements.
Carol Ponton: Buddy statements.
Matthew Hill: It’s a third in a four-part series on buddy statements and their importance in your claim. The first one was just the overall importance of buddy statements, and then we talked about how to create one.
Now we want to jump into specifics. Here we’re going to talk about service connection claims, proving that your disability is related to service and using buddy statements to do it. We see this right now where we seem to see this a bunch is with Thailand and veterans trying to prove they’re exposed to agent orange, herbicides, while they were in Thailand and using other veterans to help for that.
Carol, what do you see?
Carol Ponton: It’s crucial to proving these cases. Unfortunately, the VA seems to take the position that nobody worked on the perimeter, although the perimeters are so close to everybody. What we have-
Matthew Hill: It’s like since everybody worked on the perimeter, nobody worked on the perimeter.
Carol Ponton: Right, and so we found that we’re able to get benefits for veterans with buddy statements. We try to get someone that we can show that was in his unit, someone replaced him in his unit, someone worked with him on the flight line, and says, “I saw them spraying,” or one of the things we have is Thailand’s a jungle.
There was no jungle around our base. You could see the jungle off in the distance, but all you saw coming up close was dead foliage. Periodically, somebody would come around and spray it. There was never a lawnmower there. There was always spraying. For that reason, I know that this was herbicide that was used there, and it killed all of the foliage. These are ways to get people benefits.
Matthew Hill: Right, and so going back to what she was saying, having somebody there, and again, laying out the predicate, laying out the foundation of, “My name’s Jimmy Smith. I served in this unit in the Army. We were stationed at this base in Thailand,” and just going down the ladder of all those things and then saying, “While I was there, I was in a hooch, and we were 15 meters from the actual perimeter. I worked on the flight line, which might have been 50 meters from the perimeter. Bob Jones was in my unit, and we worked together. We were there for 10 months,” so just laying out what the person knows, how they are connected to either the veteran or the place and time. Then that just gives further evidence of what was going on with the veteran.
With Thailand, it’s just the VA stance is just nonsensical. They’re making each and every veteran fight this as if they grant benefits for one of our veterans saying, “Okay, you were close to the flight line. Therefore, you were close to the perimeter, and we’ll give you benefits.” But when it comes to the next veteran-
Carol Ponton: You’ve got to start all over again.
Matthew Hill: It’s like they have amnesia.
Carol Ponton: One of the things that we use for a buddy statement is maps, photos. It’s really important to take a photo of the base and show where were you living, where were you working. When you went off base, did you go across the perimeter? Then I have veterans that have the hooches that maybe they lived in that had no windows. They would talk about the fact that there would be storms blowing dust through there, or that they would have … one of them had a garden and said the people who went around spraying for herbicides and killed their entire garden.
What you want to do is draw a picture. The clearer you can make it for the VA, the better chance you have of winning. The more people that can verify this is what was going on, the better chance.
Matthew Hill: Right. It’s your story, and you’ve got to tell your story. The VA doesn’t believe your story, so you need to have supporting characters. You need to have others verify what they can of your story. Again, this is one of the most important pieces of evidence you get, because you can create this. You are in control of this to the extent that you know people who are there with you. You know people who served where you served, and you can get their statements to help you win your case.
Carol Ponton: Exactly. If you’re not in touch with someone, you don’t know how to get a hold of them, go online. There are a lot of people now that are going online searching for other people or people that have put statements online, because they’ve been so frustrated about what happened to them. There are pictures of Udorn or all the other bases in Thailand. You can bring that picture, make a map yourself of what happened, and then give it to your friend for them to identify.
Matthew Hill: Just, yeah, say where they were.
Thank you again for tuning in. This is a third part in a four part series on buddy statements. Again, we talked today about service connection and how you can get your case connected to service through the help of buddy statements. The next one we’re going to do is going to be on increased rating and buddy statements. Thanks.

 

Anne Linscott, Attorney

Progressive Supranuclear Palsy and the VA

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What is PSP?

Progressive Supranuclear Palsy (PSP) is a brain disorder that affects movement, control of walking and balance, speech, swallowing, vision, mood and behavior, and thinking.  This disease is caused by damage to nerve cells in the brain. Symptoms of PSP include:

  • Loss of balance while walking (this is the most common symptom that is first noticed)
  • Blurring of vision
  • Problems controlling eye movement (PSP often causes trouble voluntarily shifting your gaze upward and/or downward)
  • Trouble controlling eyelids
  • Inability to maintain eye contact during a conversation
  • Depression
  • Losing interest in ordinary pleasurable activities
  • Increased irritability and forgetfulness
  • Changes in judgment, insight, and problem solving
  • Difficulty finding words
  • Speech becomes slower and slurred
  • Difficulty swallowing solid foods or liquids

Many symptoms of Progressive Supranuclear Palsy are also symptoms of Parkinson’s disorder. Because of this, PSP is often misdiagnosed as Parkinson’s disease. However, PSP actually progresses faster than Parkinson’s. Other differences between PSP and Parkinson’s include:

  • People with PSP usually stand exceptionally straight or tilt their heads backward, and tend to fall backward while people with Parkinson’s usually bend forward.
  • Problems with speech and swallowing are more common and more severe with PSP versus Parkinson’s and also tend to present earlier with PSD.
  • Tremors are rare with PSP, but are very common with Parkinson’s.
  • People with PSP respond minimally and briefly to the drug levodopa, while those with Parkinson’s typically have much more successful responses to the drug.

Claims for Service Connection for PSP

Veterans exposed to Agent Orange can receive presumptive service connection for certain diseases including Parkinson’s disease. Despite the extensive similarities between Parkinson’s and Progressive Supranuclear Palsy, the VA does not grant service connection for PSP on a presumptive basis. However, that does not mean service connection cannot be granted on a direct basis.

Additionally, there is ample research that suggests PSP is related to exposure to Agent Orange. The National Academy of Sciences’ Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides was charged with determining whether a statistical association between herbicide exposure and PSP existed. The Committee then published Veterans and Agent Orange Update 2014 (published in 2016). In this update, the Committee stated that unless the VA could definitively establish (on a case by case basis) that the veteran’s PSP symptoms are related to an agent other than herbicides sprayed in Vietnam or related to a specific genetic condition.

So, if you receive a rating decision that denies service connection for PSP on the basis that it is not a presumptive condition associated with Agent Orange exposure, keep fighting. The VA has to consider evidence of direct service connection. The best evidence for direct service connection is getting a medical opinion from a doctor stating that your diagnosis of PSP is related to your military service. Be sure that the doctor providing the opinion gives thorough reasoning to support their findings. Also, based on the findings of The National Academy of Sciences’ Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides, it would be good to have your doctor provide their opinion as to whether your PSP diagnosis could be the result of any other type of exposure or the result of a genetic condition. By ruling out other causes of PSP, the evidence is even stronger that PSP is related to Agent Orange exposure.  Just because PSP isn’t presumptive, doesn’t mean the VA can ignore direct service connection.

Cassandra Crosby, Claims Advocate

Proving Service Connection Without Service Treatment Records

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Many veterans have illnesses or injuries that occurred while they were active duty but there are no records of the illness or injury. There can be many reasons; records get lost, the veteran was treated at civilian medical installation and the records have been destroyed; the veteran didn’t get treatment because they were worried they might get medically discharged due to the illness or injury. Whatever the reason, just because there are no records does not always mean that a disability cannot be service connected.

What is Service Connection?

When a veteran files for disability compensation, there are several types of claims the veteran can file; direct service-connected; service-connection through aggravation, presumptive service-connection, secondary service-connection, and service connection for injuries caused by the VA Health System. These different types of service connection are explained in detail in our blog What is VA Service Connection and Establishing Service Connection and the VA. Basically what service connection means is exactly what it says, the injury or illness was connected to the active duty military service. Now, that does not mean that the veteran is limited to being harmed in combat or training. It also included any injury or illness experienced during the time the veteran was Active Duty as long as the injury was not due to willful misconduct. They may also include diseases or injuries that occur after service but are secondary to an illness or injury that did occur in service.

Evidence: Proving an In Service Injury or Illness

Every claim filed with the VA must have some type of evidence to corroborate the claim. Evidence requirements vary based on the type of claim and the issue being claimed. For an average claim, one without presumption or an injury caused by combat or being a POW, there are usually specific types of evidence a veteran needs to show service connection.

  1. The onset of the illness or an injury documented during active duty service;
  2. Treatment records that are relatively consistent between the time of illness or injury and the date of the claim; and
  3. Records showing a current diagnosis of the illness or injury residual and how they cause disability, even if it is just pain or having to change something such as diet or lifestyle, adding weight gainers for people underweight and so on.

Sometimes, there are no records of treatment in service. There are many reasons why, but one of the main reasons is that active duty military members do not want to go to the doctor for fear of being medically discharged for something that is potentially going to limit them from doing their job. They will just put up with it until they retire or get out, then they will see a doctor. Several other reasons are that the records were destroyed, were not even kept (often this happens in the field such as deployed training exercises, survival training, or in combat situations, anywhere there is no official military medical installation).

The VA has a “duty to assist” by law. The law, the Veteran’s Claims Assistance Act (VCAA) defines the VA’s role and responsibilities in assisting veterans in developing their claims by attempting to obtain evidence from Federal agencies and providing a VA medical exam or a medical opinion if deemed necessary.

Lay Evidence

Again, what if they don’t exist? This is where another type of evidence comes into play. Lay evidence is evidence that does not come from professional sources. Getting people who knew the veteran while in service who can attest to the condition of their health (no medical diagnosis, but personal observations), or who can recollect and corroborate an injury or event that caused an injury can also serve as evidence. Lay evidence must meet certain criteria to be considered by the VA. It must be credible and competent. This means that it must be believable and fit with any other evidence that is provided such as current medical records. If a fellow troop makes a buddy statement saying a veteran he served with broke his leg on a hike during training. However, the current X-rays do not show evidence of an old fracture. Therefore, that would not be a credible statement because the current evidence disputes the lay statement. If a mother makes a statement that her veteran son, who was on a ship, had bronchitis. That would not be a competent statement as she is not a medical professional who can access the veteran to make a diagnosis. What they can provide is a statement that the first veteran hurt his leg when he fell and the second veteran was coughing a lot. Only professionally licensed personnel can make a diagnosis. Moreover, exaggerations of events will only serve to ruin the credibility of any other evidence that person submits on the veteran’s behalf, no matter how true it is.

Other Avenues of Research

Another way is to find other incidents that can show a probability that an injury or illness occurred. Deck logs, installation newspaper articles, veteran newsgroups, ship yearbooks, and various other researchable places exist where evidence can be sought out. Proving that someone was injured in a car accident when the records were destroyed is much easier if something like an accident report, car insurance claim, or article in the paper can be found. Having a representative to assist with the claim can also help provide veterans with researchers who can try to find that evidence to prove the claim. It does not always work, the road is not always smooth and straight, but if you do not try, the answer will always be no.

Cassandra Crosby, Claims Advocate

Guide to Proving Service Connection of PTSD

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Service connection for an injury or illness seems easy to prove; medical records documenting that the injury or illness occurred or was first treated while in service is enough to show service connection. Some are easy such as falling off a ladder and connecting that with later back problems. However, some are much more difficult, especially when there may not be any treatment records at all. The most prevalent of these is PTSD.

Victims of PTSD often do not seek treatment

Because of stigma, denial, not knowing they have PTSD, or other issues, many service members do not seek out treatment for PTSD while they are in service or sometimes for years after discharge. PTSD is the third most prevalent disability claim in the VA system yet is probably the least treated.  Many veterans did not seek out mental health treatment in service due to the stigma and possibility of being discharged for mental instability. Often, if they were fortunate, they would seek help at a local community mental health agency or a private doctor whose records could be available to assist with filing their claim, showing in service treatment. However, this is not very often the case. Most often, service members go without treatment altogether.  Only about 50% of Veterans with PTSD seek treatment, and then only about 50% of those receive adequate treatment. When Veterans finally do seek services, it is often at a point where they have reached a very low point in their lives. Many have lost relationships, jobs, homes, and even their self-worth before they seek help. Some have been hospitalized, fallen victim to substance abuse, or have legal problems because of the symptoms of PTSD and how they manifest. Unfortunately, many also commit suicide before they can get help, or because they are not getting the help they need quick enough.

What Causes PTSD?

PTSD can be caused by many different issues and can manifest in very different ways for each individual. What may trigger PTSD symptoms in one person, may not cause any symptoms in another. The VA bases their PTSD definitions on the DSM-V Criteria. The criteria for PTSD are: whether the veteran was directly exposed to a traumatic event; if they witnessed a traumatic event; if they learned that a close friend or relative was exposed to a traumatic event (if involving death it must have been violent or accidental in nature); or repeated or extreme indirect exposure to aversive details of the event (such as first responders, medics, firemen, etc.).  There are also criteria for intrusion symptoms; avoidance, negative alterations in cognitions and mood; alterations in arousal and reactivity, duration, functional significance, and exclusion. When these areas are reviewed, a determination is then made if the Veteran meets the DSM-V criteria for PTSD.

Because everyone has different coping skills and reactions; someone who sees death and destruction on a daily basis serving as a medic in a war zone may meet no criteria for PTSD, yet someone who experiences a fire in their barracks during basic training may end up experiencing many criteria for PTSD. It doesn’t mean a person is strong or weak, only that their minds have reacted differently to different events and they may have different coping skills to deal with what they are exposed to.

Service Records v. Service Medical Records

One of the first things that the VA does when a Veteran files a claim for PTSD is request service medical records. If the Veteran has experienced a traumatic event that may have caused immediate injury or that the Veteran sought out medical or mental health treatment for, it would be present in their medical records. Also, since the onset of the Gulf War, pre- and post-deployment questionnaires address the questions of mental health issues as a course of record. However, again that stigma is present and someone who may not want to be medically discharged or sent back stateside may not seek treatment or tell the truth on forms in order to keep their job and duty station.

So, if there are no medical records, how can someone go about proving that the incident occurred in service? One way is be requesting that the VA review your Service Records as well as your medical records. By reviewing your service records, there may be what are called markers to PTSD or mental health issues such as sudden disciplinary issues, a sudden drop in performance review scores; a request for a change in duty station or different squad, company, or platoon; records of going AWOL; or other issues such as excessive drinking, dereliction of duty, insubordination, etc. Any types of behaviors that were not present before the incident but become prevalent after may be considered markers of a traumatic event.

Other forms of “Proof”

There are a few other ways to show that a traumatic event happened when you don’t have any “proof” of it. Stressor verification can be determined by:

  1. Buddy Statements – written statements from friends, other service members, or relatives who either witnessed the event, discussed it with you when it happened, or noticed a behavior change after the event.
  2. Help Program records – if you called any support groups, helplines, churches, or other programs that offered support and help, document it or try to get copies of your records with those agencies.
  3. Civilian reports such as police reports if the incident was reported to civilian authorities but not military authorities (for example, a car accident and the Veteran’s best friend is killed while he is home on leave);

A Veteran will also have to fill out a PTSD Stressor Statement form and attend a C&P Exam. There are tips on what to do to prepare for the C&P Exam here.

Getting Help

Getting help with filing your claim helps increase the chances of it getting approved. However, for those with PTSD, it can also relieve some of the stress that Veterans experience dealing with the claims process. If you need help filing your claim, please call your local Veteran’s Organization for assistance or an attorney if you have an initial denial. Professional help increases your chances of winning your claim by almost 25% and can greatly reduce the stress on you.

Most importantly, remember that no matter what happens with your claim, it is vital that you seek help to deal with your symptoms. PTSD is one of the leading causes of suicide among Veterans and seeking help will reduce the risk of suicide. If you are experiencing thoughts of harming yourself or others, please call 911 immediately. Other resources available for Veterans include:

  • 911 or go to the nearest emergency room;
  • Veterans Crisis Line – 1-800-273-8255 and press 1 or text 838255;
  • Wounded Warrior Project
  • The Soldier Project has a list of resources including homeless programs, financial assistance for medications, therapy programs, and support groups.
Cassandra Crosby, Claims Advocate

Jet Fuel Exposure Causes Hearing Loss??

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Living in and near Air Force bases most of my life, my daughter’s favorite saying was “Jet Noise, the sound of Freedom.”  We all had the bumper stickers on our cars, especially during those times when certain politicians wanted to dismantle some of our larger bases, we let them all know that the sound of jet noise was music to the ears of every patriotic American in the world. We also knew that exposure to jet noise leads to hearing loss. All those troops, regardless of which branch they served in, who were exposed to jet noise either on flight lines, in combat, or just sitting in their offices under the path of the planes know all too well the results of the sound of freedom.

New studies have shown that it isn’t just the noise that has affected our troops hearing, it is also the fumes from the fuel. According to studies done by the Center for Disease Control (CDC); JP-5, JP-8, and Jet A fuels, those commonly used in commercial and military aircraft, are responsible for a myriad of health concerns, including hearing loss.  While the fuel alone isn’t responsible for hearing loss, the combination of noise and fuel exposure increases the rate of hearing loss substantially over that of just noise exposure. The VA has also been conducting studies and is finding similar results. The problem is not that the fuel actually causes damage to your ears, but that it causes neurological problems in the brain that prevent the brain from deciphering what the ears hear into understandable language.  When combined with noise exposure, the risk increases greatly.  The study the VA has used worked mainly with JP-8 fuel and showed definitive links to auditory processing dysfunctions among those who had exposure to the fuel.

How the Brain Translates Sound

The sound we hear is captured by the ears and the ears then send electrical signals to the auditory nerve. These impulses are then transferred to the auditory center of the brain. When the auditory center of the brain is triggered, several groups of neurons receive the impulses and translate them into language that our brains understand. This translation allows us to consciously perceive the sounds that we hear. There are three main auditory pathways the impulses must travel through for complete translation. First is the brain stem. This is the area at the bottom and back of our brains that controls our basic functions of the body such as breathing, heart rate, consciousness, and links the rest of the body’s nerve system to the brain. 

The next part of the translation occurs in the thalamus. The thalamus is a part of the brain that is responsible for sensory perception and movement. It regulates our body’s voluntary motor control, our sleep/wake cycles, and our senses of sight, sound, taste, touch, and where we are in our environment or our perception of the space around us. It tells us that the chair is right there and if we sit 3 inches to the left we will miss it and fall to the floor.

The final translator is the auditory cortex. At this point, the messages we have heard have already been mostly translated but the auditory cortex finalizes the process, stores what we have heard into our memory and formulates a response, be it language or action.

How Jet Fuel Disrupts Sound Translation

The study of JP-8 showed distinct brainstem dysfunctions after exposure, causing impulses from the ears to not be transmitted properly to the next step in the auditory pathway, therefore causing the brain to be unable to translate what the person hears. Unfortunately, when people affected by this issue take a hearing test, they pass, because they can hear. What they can’t do is translate the language. So they know something is wrong with their hearing but they are not able to explain correctly what exactly is wrong. It is similar to dyslexia, the eyes can see the letters but the brain translates the images in a different order. Someone with dyslexia may see:

which makes it very difficult to read properly. The effect that jet fuel has on the hearing is very similar in the effect of translation.

If you were exposed to jet fuel and are having problems understanding when someone speaks, inform the VA that you need to speak to someone about hearing loss and explain to them about your exposure. Understand that you may need to inform your audiologist about the study and ask them to research it and possibly refer you to someone who has done research on this issue and can evaluate your issue taking your exposure issues into account.

Mary Klements, Claims Advocate

Service-Connecting GERD: What You Need to Know

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Among gastrointestinal disorders, gastroesophageal reflux disease (GERD) is a very common condition that is associated with heartburn. In fact, according to the National Institute of Diabetes and Kidney Digestive Disease, approximately sixty million people experience heartburn at least once a month, and twenty-five million experience the symptoms daily. The purpose of this post is to explain what GERD is and how you can obtain service-connection from the VA for this condition.

What exactly is GERD?

gerdGERD is a condition in which gastric acid and partially digested food flow up from the stomach into the esophagus. This results in the painful sensations that are associated with heartburn. Continuous irritation of the esophageal lining poses a risk for developing more severe complications such as esophageal cancer.

Symptoms of GERD include:

  • Heartburn
  • Nausea
  • Pain in chest or upper abdomen
  • Difficulty swallowing or painful swallowing
  • Respiratory problems
  • Vomiting

How does GERD occur?

The esophagus, commonly called the food pipe, is a narrow muscular tube that is about 9.5 inches long. It connects the back of the mouth with the stomach. When you swallow food, muscles in the esophagus move the food toward the stomach. At the base of the esophagus is a band of muscle, called the lower esophageal sphincter (LES), which opens and closes to allow food and liquids to pass into the stomach. Except for belching, this is the only time that the LES is supposed to open. Once food and liquids have passed safely into the stomach, the acids and enzymes in the stomach begin to break down the starch, protein and fat in the food. While the stomach has a lining tough enough to withstand the acid, the esophagus does not.

What happens in cases of GERD is the LES opens when it is not supposed to—namely after the enzymes and acids have started working on the contents of the stomach. When this occurs, gastric acid and partially digested food flow back up into the esophagus. The lining in the esophagus, as mentioned before, is not thick enough to withstand acid, and this causes the burning sensation in the chest and throat. In its normal, healthy state, the LES opens and closes when it is supposed to. However, if the muscle weakens, it may not be able to close completely after swallowing, and therefore may allow gastric acid and partially digested food to escape the stomach.

What causes GERD?

It is a well-established fact that certain medications, lifestyle choices, and non-related physical disorders can contribute to GERD. Not only do some medications weaken the LES, but also some medications and outside factors can aggravate the already-irritated esophageal lining.

Medications

There are some medications that are known to weaken or relax the LES. Many of these act as muscle relaxants, and can cause the wrong muscles to relax, such as the LES. These medications include:

  • Calcium channel blockers
  • Anticholinergics (used to treat urinary tract disorders, allergies, and glaucoma)
  • Beta adrenergic agonists (used to treat asthma and obstructive lung diseases)
  • Dopamine agonists (used to treat Parkinson’s)
  • Antidepressants
  • Sedatives
  • Narcotics

There are also medications that irritate the esophageal lining, such as:

  • NSAIDs, such as ibuprofen and naproxen (Aleve)
  • Potassium
  • Iron pills
  • Bisphosphonates (used to treat osteoporosis)
  • Antibiotics

Risk factors

There are many risk factors for heartburn and GERD. Many of them necessitate the regular consumption of medications listed above.

  • Eating pattern: People who eat heavy meals and then lie on their back or go to bed are at risk for heartburn
  • Pregnancy: Symptoms of GERD are often unavoidable during the third trimester, then the growing uterus puts pressure on the stomach and forces acids and partially digested food back up through the LES.
  • Obesity
  • Respiratory Disorders: People with asthma and COPD have a high risk of GERD. This is due not only to the medications which they must take to control their symptoms, but also due to the chronic irritation that these disorders inflict on the esophagus.
  • Smoking: Studies have shown that smoking reduces LES muscle function, increases acid secretion, impairs muscle reflexes in the throat, and damages protective mucus membranes. Smoking also reduces salivation, which helps neutralize acid.
  • Alcohol Use: There are mixed opinions on this particular risk factor. Alcohol is known to relax the LES muscles and, in high amounts, may irritate the lining of the esophagus. Other studies, however, have shown some types of alcohol, such as wine, to actually protect the lining of the esophagus.

What does this mean for your VA case?

GERD is one of those interesting and rather inexplicable exceptions to the VA rules. For example, the VA’s regulations on presumptive Persian Gulf War conditions (conditions which are automatically considered service-connected if you meet the qualifying criteria) include gastrointestinal disorders. However, there is a caveat to this. These regulations only apply to functional gastrointestinal disorders, which involve abnormal functions of an organ in the gastrointestinal tract, without a structural alteration in the tissues (such as irritable bowel syndrome). GERD is not considered a functional gastrointestinal disorder; rather, it is considered a structural gastrointestinal disorder. On top of it all, there is not even a rating schedule for GERD in the VA rulebook.

One can argue that this does not make any sense. But while this particular regulation does make it harder to obtain service-connection for GERD, there are ways to get around this.

Direct Service Connection

If you were diagnosed with GERD while on Active Duty, and if a medical expert provides a favorable opinion that your GERD condition began during and has continued since service, you can obtain service connection on a direct basis.

Secondary Service Connection

Service connection can be granted on a secondary basis if a medical expert can provide a favorable opinion that one condition was developed secondarily to a condition that has already been service-connected. In this particular case, we mentioned respiratory conditions as being a risk factor for GERD. Say, for example, the VA has service-connected you for COPD. Over time, you developed GERD due to chronic irritation of the esophagus and due to the effects of the medications that help control your COPD. You can file a claim for GERD secondary to COPD. However, you will need a doctor or medical practitioner’s opinion that your COPD condition caused or aggravated GERD.

Cassandra Crosby, Claims Advocate

Veterans and Service Connected Migraines

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Migraines are not like other headaches, just ask someone who has had one. Comparing a migraine to a headache is like comparing a toy train to the super-train in Japan, there really isn’t any comparison. A migraine can be completely debilitating and so intense that sufferers will do almost anything to relieve the pain. Sufferers of migraines have done everything from banging their heads against walls, taking large doses of medications, essential oils, diet changes, activity changes, etc. The lists of things a migraine sufferer will do to stop or decrease the pain can be as lengthy as a child’s Christmas wish list. However, very few treatments really work to reduce the pain, and very little is actually known about the causes and treatment of migraines.

Migraines actually have several phases, up to four in many people, and can last from hours to days. They can cause pain so severe that it can render a person completely incapacitated. Some people have warning signs prior to a migraine.

  • Prodome: The first phase can start several days before the actual headache starts. These symptoms include mood changes; constipation; food cravings; frequent yawning; increased thirst and urination; and/or neck stiffness.
  • Aura: The second phase of the migraine can include; flashes of light; bind spots or other visual disturbances; tingling of one side of the face, arm, or leg; hearing music or noises; touching sensations such as sensory, motor, or verbal disturbances; weakness of muscles or feeling as if someone is touching you; and/or a specific type of headache that precedes the actual migraine.
  • Migraine: The third phase is the actual migraine itself and has specific symptoms that other headaches do not have. A migraine can last upwards of 72 hours and can have such symptoms as; pain on only one side of their head; throbbing or pulsing pain; nausea and/or vomiting; sensitivity to light, sound, smells; blurred vision; and/or lightheadedness or fainting spells.
  • Post-drome: The fourth phase is the last phase of a migraine and the sufferer can experience such symptoms as; feeling drained and washed out or elated; confusion; moodiness; dizziness and/or continued sensitivity to light and/or sound.

Service Connection of Migraines

cc-migraines-graphMigraines are one of the more prevalent claimed disabilities among Veterans. It is currently ranked 8th in most prevalent disabilities in new compensation claims. Studies suggest that approximately 36% of those returning from Iraq experience migraine type headaches. Another study showed that of those suffering from migraine type symptoms, about 22% showed symptoms of anxiety, 50% showed symptoms of depression, and almost 40% had symptoms of PTSD. The exact causes of migraines remain unknown, but there are links. Traumatic brain injuries such as exposure to explosives, extremely loud noises, and actual head injuries are leading factors in migraines. However, there are now links to exposures to chemicals such as burn pits and chemical solvents.  There may also be secondary links such as the neck, eye, or back injuries, fibromyalgia, and mental health issues.  There can also be other secondary issues from the migraines such as sleep disorders, chronic mental health issues such as depression.  Detailed information on how migraines are rated can be found here.

Filing a VA Claim for Migraines

A Veteran first must have a diagnosis of migraines in order to file for disability compensation. Second, it must be determined if the migraines are the primary disability (caused by an in-service injury or event) or if they are secondary to another injury or illness. If they are a primary disability, you can claim them alone; if they are a secondary disability then you must claim the primary disability as well as the migraines (if you are not already service-connected for the primary disability).

If the migraine is primary, there are several ways to show proof of migraines being service connected in order to file a claim. If a Veteran can show that they were treated for migraines in service with service medical records or can show an injury or illness in service that caused migraines with a nexus statement from a physician then there is the likelihood they can get service connection for their migraines. Proving service connection without that proof is more difficult, but it is possible. Having proof of exposure to certain environmental issues such as burn pits, extremely loud noises, or being in close range of explosives can provide nexus or link the migraine to military service.

If the migraine is secondary, the Veteran will need the diagnosis, treatment records, and the nexus showing that the primary disability caused or probably caused (50% or greater likelihood) the migraines. More in-depth information about secondary service-connection can be found here.

Treatment of Migraines

Some new treatments have been making the scene lately with positive results. Most medications are hit or miss; some having to be taken within a limited time frame for effectiveness, others have side effects that are often as bad as the migraines, and some having limits on how much can be taken in a week/month so that sufferers are discouraged from using them for fear of running out. New treatments such as Botox injections and Cefaly treatments can be costly if you are not already service connected and your VA Clinic does not provide these treatments.  Regardless of whether a Veteran has a claim for disability or not, treatment for migraines is available and should be taken advantage of if possible. Migraines are debilitating and can decrease the quality of life tremendously so do whatever possible to get treatment.

Robert Rivera, Claims Advocate

Gulf War Syndrome and How It May Be affecting You Today

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Gulf War Syndrome is a collection of potentially debilitating symptoms that may be present in many veterans of the 1990’s Gulf War. The Department of Veteran Affairs doesn’t like the term Gulf War Syndrome, preferring to categorize the condition as “chronic multi-symptom illness,” or sometimes simply as “undiagnosed illnesses.”(1) Gulf War Syndrome (GWS), also known as ‘Desert Storm Diseases’ or simply ‘Gulf War Illness’, share symptoms that have been reported by veterans and civilians (like press and government employees), of the first Gulf War (as early as August 1990).

Veterans from every country that made up the Coalition forces have been affected. In the US alone, more than 110,000 cases had been reported by 1999, according to official government sources. It is estimated that it may affect as many as thirty percent of the men and women who served during the conflict. While the exact cause remains unknown, the same study found that veterans who experience these symptoms also experienced a loss of Brain Matter. (1)

There is even a report relating to military personnel in Kansas developing flu-like symptoms and chemical sensitivities after handling archived documents returned from the Gulf War. (1)

Military Service Connection

Gulf War Veterans who meet the criteria do not need to prove a connection between their military service and illnesses in order to receive VA disability compensation. The VA presumes certain chronic, unexplained symptoms existing for 6 months or more are related to Gulf War service without regard to cause. These “presumptive” illnesses must have appeared during active duty in the South West Asia theater of Military Operations or by December 31, 2021 and be at least 10% debilitating. (2) These illnesses include:

Chronic Fatigue Syndrome – a condition of long-term and severe fatigue that is not relieved by rest and is not directly caused by other conditions.

Fibromyalgia – a condition characterized by widespread muscle pain. Other symptoms may include insomnia, morning stiffness, headache, and memory problems.

Functional gastrointestinal disorders – a group of conditions marked by chronic or recurrent symptoms related to any part of the gastrointestinal tract. Functional condition refers to an abnormal function of an organ, without a structural alteration in the tissues. Examples include; irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain syndrome. Undiagnosed illnesses with symptoms that may include but are not limited to: abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headache, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders, and sleep disturbances. (2)

In the UK, veterans of the 2003 conflict began reporting symptoms identical to those reported by

Veterans of the first war, shortly after they returned from duty. The symptoms reported by veterans include but are not limited to:

  • Fatigue
  • Persistent Headaches
  • Muscle Aches/Pains
  • Neurological Symptoms – e.g. tingling and numbness in limbs
  • Cognitive Dysfunction – short-term memory loss, poor concentration, inability to retain information
  • Mood and Sleep Disturbances – Depression, Anxiety, Insomnia.
  • Dermatological Symptoms – Skin Rashes, Unusual Hair loss.
  • Respiratory Symptoms – Persistent Coughing, Bronchitis, Asthma
  • Chemical Sensitivities
  • Gastrointestinal Symptoms – Diarrhea, Constipation, Nausea,
  • Bloating.
  • Cardiovascular Symptoms
  • Menstrual Symptoms

Note: This list does not reflect all symptoms, they vary widely.

You have probably noticed that these symptoms are remarkably similar to those attributed to chronic fatigue syndrome, multiple chemical sensitivities, and other environmental illnesses. This similarity hasn’t gone unnoticed which is why many people, including healthcare professionals and researchers, are coming to the conclusion that all these illnesses share some common causes and etiologies. (3)

What Caused Gulf War Syndrome?

There were many factors present in the Gulf during the war that could have played a role in causing illness in those present at the time. It is likely that a combination of these factors together is what led to the illness.

Potential Causative Factors
  1. Infectious Diseases – A number of infectious agents were present in the Gulf but medical records generally show that they weren’t a major problem for personnel due to extensive precautionary measures. Of course, many infectious agents may lie dormant without causing an acute illness. The most common infectious agents present were thought to be cutaneous travelers, diarrhea, sand-fly fever, and malaria. One unique infectious disease has been linked to the Gulf war deployment; (Leishmaniasis). Leishmaniasis is a parasitic disease found in parts of the tropics, subtropics, and southern Europe. Leishmaniasis has several different forms. CL is transmitted through the bite of an infected female phlebotomine sand fly but can also occur after accidental occupational (laboratory) exposures to Leishmania parasites. (3)
  2. Biological Weapons – Exposure to biological warfare agents has been put forward as a possible causative factor in Gulf war syndrome. No evidence that such an agent was deployed has been found however. It should be noted however that Iraq was known to be experimenting with the use of anthrax and an organism responsible for gangrene. There is also the possibility that Iraq deployed bio-toxins; toxins produced by living organisms such as bacteria. Endotoxins, those given off when a cell dies, can produce similar effects to chemical toxins/weapons and do not cause infectious disease as a living organism would. (3)
  3. Chemical Weapons – As with biological agents, chemical warfare agents have also been suggested. There is more concern here however as it is known that a number of Iraqi facilities containing chemical agents were hit during the air and ground offensives which could have led to low-level exposure to Coalition troops. (3)

Other Chemical Agents – Besides possible exposure to chemical warfare agents, the coalition troops were constantly exposed to chemicals whose use is considered safe. It must be noted, however, that they were just the type of chemicals reported to cause symptoms in multiple volatile organic compounds.(3)

Chemicals

Organophosphate Pesticides -Organophosphates are the basis of many insecticides, herbicides, and nerve agents. The United States Environmental Protection Agency lists organophosphates as very highly acutely toxic to bees, wildlife, and humans. Recent studies suggest a possible link to adverse effects in the neurobehavioral development of fetuses and children, even at very low levels of exposure. (3)

Pyridostigmine Bromide – A drug given to troops to counteract chemical warfare agents. (3)

CARC – Chemical agent resistant coating is a specialized form of automobile paint, designed to prevent chemical warfare agents leaching onto a vehicle’s finish. According to manufacturers’ data sheets, chronic overexposure to the paint’s vapor can lead to asthma-like symptoms.

Prolonged exposure can permanently damage the brain, nervous system, liver, and kidneys. (3)

Fuel – Gulf War veterans often recall an association between diesel and petrochemical fume exposure and symptoms during service. Many suspect these exposures may be the cause of their ongoing health complaints after the war. (3)

Decontamination Solutions – Decontamination solutions were widely used in the gulf to sterilize vehicles, equipment etc. The decontamination agent used most widely in the first gulf war was decontamination solution 2 (DS-2). DS-2 is an effective decontamination agent but is highly caustic and is known to damage equipment, pollute the environment and cause personal injury, according to experts. (3)

Oil Well Fire Smoke – The retreating Iraqi army ignited approximately 600 oil wells in February 1991 which burned for about 9 months. These fires produced massive amounts of thick smoke which sometimes drifted to ground level causing increased exposure to ground troops. When this occurred, the air pollution was far greater than would be experienced in the average traffic congested western city. (3)

Vaccinations – Troops sent to the Gulf were given a large cocktail of vaccinations in a short period of time. In total, US servicemen may have received as many as 17 different vaccines, including live vaccines (polio and yellow fever) as well as experimental vaccines that had not been approved (anthrax, botulinum toxoid) and were of doubtful efficacy . In the UK, the Ministry of Defense has declared only 10 vaccines given but reports from veterans and official documents seem to tell a different story. (3)

Depleted Uranium (DU) – During the Gulf war, depleted uranium was used for the first time, both in vehicle armor and offensive munitions, as well as in various other components of vehicles and other equipment. It was used widely due to it being cheap and widely available as a by-product of nuclear energy and nuclear weapon production. In Operation Desert Storm over 350 metric tons of DU was used, with an estimate of 3-6 million grams released in the atmosphere. Inhaling particles of depleted uranium may have contributed to sickness after the war due to DU’s chemical and radiological toxicity and mutagenic and carcinogenic properties. Internal contamination with inhaled DU has been demonstrated by the elevated excretion of uranium isotopes in the urine of the exposed veterans 10 years after the Gulf War. (3)

 

Works Cited

(1)7 Veteran Health Concerns We Never Talk About; Written by Anna Schaefer

Medically Reviewed by Peggy Pletcher, MS, RD, LD, CDE on November 9, 2015, Available at http://www.healthline.com/health/veteran-health-concerns#2

(2) U.S. Department of Veterans Affairs; Public Health; Military Service Connection, Available at http://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp

(3) The Environmental Illness Resource; Gul War Syndrome, Available at http://www.ei-resource.org/illness-information/environmental-illnesses/gulf-war-syndrome/

Cassandra Crosby, Claims Advocate

Don’t Forget to Claim Secondary Disabilities

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Secondary disabilities are defined as those illnesses or injuries that are caused or aggravated by a service-connected disability. See our blog for a more in-depth definition of Secondary Service Connection here. There are two distinct categories; secondary service connection and secondary service connection by aggravation. So, first let’s define them then discuss what you need to file a claim for them.

Secondary Service Connectioncc-secondary-connection

This means that a service-connected illness or injury caused another illness or injury. For example, diabetes is one of the most common service-connected illnesses. If a veteran with diabetes develops complications from diabetes such as stroke, kidney failure, peripheral neuropathy, vascular disease, etc., those could then be claimed as secondary to a service-connected disability. There must be evidence that the service connected disability directly caused the secondary illness or injury. So, you cannot claim that diabetes caused Parkinson’s Disease, but you can claim it caused blindness or loss of a limb if you have evidence showing the diagnosis and progression.

Secondary Service Aggravation

Secondary service aggravation is a little different in that it is not something that was directly caused by the service-connected illness or injury but was aggravated by it enough that it is now an issue of its own. An example of this would be that someone has flat feet diagnosed in service and is service connected for that illness. Now, several years later they are diagnosed with rheumatoid arthritis in their back and as time goes on it progresses to the point where they have to have surgery and possibly assistance walking such as with a cane or walker. Now, while rheumatoid arthritis is genetic, and therefore cannot be service connected; it can be aggravated by the abnormal gait caused by the flat feet condition. Also, something to note, while the initial service connected disability may have a low rating, the aggravated secondary condition may get a much higher one. In this case, the flat feet may have only been rated at 0-10% but the debilitating effects of rheumatoid arthritis in the back being aggravated may have now caused loss of independence and could possibly be rated up to 100% or warrant unemployability, aid and attendance, or special adaptive home grants.

Progression

Progression is shown by first having a primary diagnosis that is service connected. Second, you must show treatment for that primary diagnosis and either the onset of the new illness or injury or the aggravation of the existing one. There must be a diagnosis of the new/aggravated illness or injury before you can file the claim. For example, you can’t file for blindness secondary to diabetes just because you may go blind, only once you have already gone blind. Having statements from your treating physicians showing how the existing illness/injury caused or aggravated the other will give you the best chance at a positive claim outcome.

Not all Secondary Conditions will Receive a Rating

Often times, because every person is different, someone will develop an illness that may be related to a service-connected disability but they are not awarded secondary connection for it. This could be the case in such issues as depression caused by diabetes or sleep apnea caused by a cervical condition. Unless you have a nexus letter from your doctor that can convince the VA of the connection, it is rare that anyone is awarded secondary service connection for issues that are not normally associated with the service connected issue. Sometimes medical personnel can find new and emerging studies and journal articles that can support the connections which will help a claim. Also, be aware of whether you are claiming that the injury or illness was caused by or aggravated by the service connected disability. If you have a genetic or hereditary issue you can not claim it was caused by the S/C issue, only aggravated. Sometimes, simple mistakes like this can cause a claim to be denied and be tied up for years in appeals until someone finds the mistake, then effective dates are lost because the claim was not filed appropriately and now a new claim must be filed. Be sure to review this with your representative or attorney when you are filing for secondary issues.

Melanie Franco, Attorney

VA Benefits for PTSD – Part 3 – The Link

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We have been looking at claims for PTSD and what it takes to get service-connected. A claim for PTSD has three requirements: 1) a diagnosis of PTSD 2) an in-service stressor 3) a link between the diagnosis and in-service stressor. In our first post, we looked at what PTSD is and the first requirement. In the second post, we took a closer look at proving the in-service stressor. In this post, we will be looking at our third requirement, the link between the diagnosis of PTSD and the in-service stressor.

Nexus Link Between PTSD Diagnosis and In-Service Stressor

The third requirement for service connection of PTSD is a nexus link established by medical evidence between the current symptoms and the in-service stressor. This link has to be provided by a medical expert, it cannot be a lay opinion by an individual.

Establishing the link between the diagnosis of PTSD and the stressor is easier than the other two requirements for PTSD. Once you meet the first requirement showing you have a current diagnosis, it’s not hard to meet the third. The medical report containing the diagnosis of PTSD will usually also have information about the traumatic event that caused it and link the diagnosis to the event.

Examination reports should also always:

  • Sufficiently describe symptomatology
  • Identify or adequately describe the stressor
  • Acknowledge and reconcile prior reports that don’t support a diagnosis of PTSD
  • Conform to the Diagnostic Statistics Manual

It’s important that any private medical report also includes this information.

The standard for the medical nexus is the same as for the rest of the VA, the medical evidence in the record only needs to be in equipoise, or roughly even, on whether the veteran’s current symptoms are connected to the in-service stressor. This is the standard of “at least as likely as not.”

If after reviewing the evidence, the VA doubts whether the veteran’s stressor contributed to the PTSD symptoms, the medical reports must be returned for clarification. If the VA denies a claim for PTSD because it does not find the veteran’s nexus medical evidence convincing, it must say so in its decision and include an adequate statement of its reasons, along with identify the medical evidence in the record showing that the medical link was not proven.

As long as there is a clear relationship between an in-service stressor and a current diagnosis of PTSD, a veteran whose service records show no evidence of a mental disorder prior to service, can be entitled to service connection for PTSD. Even if PTSD develops many years after service, the VA has recognized that PTSD can develop hours, months, or even years after a stressor.

Once the veteran has submitted a medical diagnosis of PTSD, the VA is now limited in its ability to deny a claim for not showing a current disability. The record would have to contain medical evidence directly contradicting the diagnosis of PTSD for the VA to find the veteran doesn’t have a current disability. Then the VA must accept that the stressor described by the veteran to the examiner was medically sufficient to support a diagnosis of PTSD, and that the veteran’s symptoms were adequate for the examiner to diagnose PTSD. If the VA doubts whether the described stressors were sufficient to cause PTSD, or the adequacy of the symptomatology described in the diagnostic report, the VA must do one of two things: 1) put aside the doubts and accept the medical report as sufficient for rating purposes, or 2) return the medical report for clarification (not necessarily to the same examiner). If clarification isn’t provided when the report is sent back, then the VA must either return the examination report again or obtain independent medical evidence concerning the issue. Ultimately, the VA cannot reject a competent diagnosis of PTSD without an adequate statement of reasons or bases for its decision, and unless it can point to other medical evidence in the record to support its conclusion that the veteran does not have PTSD.

There are some cases where there are conflicting diagnoses in the record, where one expert opinion might conclude that the veteran has PTSD, and another expert concludes that the veteran either a) does not have PTSD, but does have another mental disorder, or b) does not have PTSD or any other mental disorder. When the evidence conflicts like this, the VA must analyze and weight the conflicting evidence in the record and making a finding one way or the other as to whether the veteran has PTSD. If the VA finds that the negative evidence outweighs the positive evidence of PTSD, the veteran can appeal. But if the BVA finds that the veteran also does not have PTSD, that decision will be upheld by a reviewing court as long as the decision is supported by medical evidence, has a plausible basis in the record, and is supported by an adequate statement of reasons and bases. The key to winning cases where there are conflicting diagnoses is to have the stronger evidence on your side.