All Branch Topic (ABT) VA Claims

[TheTruckGuy]

Does anyone know more about these and what level of evidence the VA needs?

I have people that either have journal article worthy anatomy, or they're making stuff up in order to get an MRI to get stuff "documented." Then of course everyone wants to "sign up" for their sleep study before retiring. A group of folks that work together and are getting out all suddenly came to see me for acid reflux. I looked it up an apparently GERD can get you 10, 30, or 60% disability, depending on severity and associated anaomty (hiatal hernia, etc).

My question is what constitutes documentation for VA claims? Am I doing someone a disservice by saying their chronic knee pain doesn't need an MRI because there's nothing surgical? Or their chronic neck pain?

I have one Marine who kept asking for an MRI, reluctantly did a few weeks of PT, then convinced an IDC to get him an MRI -> Stone cold normal knee. I'm sure he has knee pain, but obviously no surgical pathology. Does that hurt his potential VA claim for knee pain?

Does documenting "6 years of shoulder pain with overhead movements that I was never seen for" on the separation physical constitute enough documentation for a VA claim? Or do they actually need to try and see physical therapy in the 2 weeks before they go on terminal?

Also, I still don't understand how sleep apnea is service connected in 95% of the people that want a sleep study. It would be interesting to do a study on the percentage of sleep studies done within 1 year of separation are positive for sleep apnea. And look at referral criteria for those that were negative.

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[DrMetal]

Does anyone know more about these and what level of evidence the VA needs?

I have people that either have journal article worthy anatomy, or they're making stuff up in order to get an MRI to get stuff "documented." Then of course everyone wants to "sign up" for their sleep study before retiring. A group of folks that work together and are getting out all suddenly came to see me for acid reflux. I looked it up an apparently GERD can get you 10, 30, or 60% disability, depending on severity and associated anaomty (hiatal hernia, etc).

My question is what constitutes documentation for VA claims? Am I doing someone a disservice by saying their chronic knee pain doesn't need an MRI because there's nothing surgical? Or their chronic neck pain?

I have one Marine who kept asking for an MRI, reluctantly did a few weeks of PT, then convinced an IDC to get him an MRI -> Stone cold normal knee. I'm sure he has knee pain, but obviously no surgical pathology. Does that hurt his potential VA claim for knee pain?

Does documenting "6 years of shoulder pain with overhead movements that I was never seen for" on the separation physical constitute enough documentation for a VA claim? Or do they actually need to try and see physical therapy in the 2 weeks before they go on terminal?

Also, I still don't understand how sleep apnea is service connected in 95% of the people that want a sleep study. It would be interesting to do a study on the percentage of sleep studies done within 1 year of separation are positive for sleep apnea. And look at referral criteria for those that were negative.

I would often get tests (sleep studies, MRIs, etc) only with in the standard of care (or the standard of whatever diagnostic algorithm I was following), and oftentimes they would come back normal. Then I could say: "Great news! You don't have sleep apnea! or your don't have any torn ligaments." Much to the patient's chagrin. Then I would document that is was completely normal, and they can't claim it otherwise.

 

[TheEarDoc]

Does anyone know more about these and what level of evidence the VA needs?

I have people that either have journal article worthy anatomy, or they're making stuff up in order to get an MRI to get stuff "documented." Then of course everyone wants to "sign up" for their sleep study before retiring. A group of folks that work together and are getting out all suddenly came to see me for acid reflux. I looked it up an apparently GERD can get you 10, 30, or 60% disability, depending on severity and associated anaomty (hiatal hernia, etc).

My question is what constitutes documentation for VA claims? Am I doing someone a disservice by saying their chronic knee pain doesn't need an MRI because there's nothing surgical? Or their chronic neck pain?

I have one Marine who kept asking for an MRI, reluctantly did a few weeks of PT, then convinced an IDC to get him an MRI -> Stone cold normal knee. I'm sure he has knee pain, but obviously no surgical pathology. Does that hurt his potential VA claim for knee pain?

Does documenting "6 years of shoulder pain with overhead movements that I was never seen for" on the separation physical constitute enough documentation for a VA claim? Or do they actually need to try and see physical therapy in the 2 weeks before they go on terminal?

Also, I still don't understand how sleep apnea is service connected in 95% of the people that want a sleep study. It would be interesting to do a study on the percentage of sleep studies done within 1 year of separation are positive for sleep apnea. And look at referral criteria for those that were negative.

The VA standards for evidence are so low (remember it just has to be 50% or greater likelihood for a favorable ruling) that even having it written somewhere in the medical records before separation from service often times is enough.

I would document simply something like "SM came to clinic complaining of X. This SM has never reported for treatment or complaints of X and was provided Y treatment" and call it a day.

 

[Dr. Wexler]

It is not your job to get the info needed for their VA claim. If the VA wants additional testing the VA will order it themselves. Order what you need to provide medical care.

 

[WernickeDO]

This is standard stuff. Your joes will come in just prior to separating and want the million dollar work up to help bolster their disability claim.

Order what you think is medically indicated, and leave your line in the sand there. If you dive too much into the gross abuse of the disability system you will surely lose your mind. If you don't order the MRI/sleep study, then they will find someone else who will, as you have learned.

 

[TheTruckGuy]

This is standard stuff. Your joes will come in just prior to separating and want the million dollar work up to help bolster their disability claim.

Order what you think is medically indicated, and leave your line in the sand there. If you dive too much into the gross abuse of the disability system you will surely lose your mind. If you don't order the MRI/sleep study, then they will find someone else who will, as you have learned.

But, for example, what's medically indicated as first line treatment is often physical therapy. If that doesn't work, then imaging is warranted if surgery is on the table.

What if someone has a torn labrum, for example, that they've been putting off dealing with for years. Am I doing them a disservice by just documenting "right shoulder pain" instead of getting an MRI and documenting "labrum tear"? Whether that disservice is streamlining them getting a labrum repair at the VA, or getting a bigger disability check because their 20 years in the infantry has taken a huge toll on their body...

Is it sufficient, for documentation purposes for, them to just claim shoulder pain on their 2807 and if later it's determined to be a labrum tear for it to be handled fairly by the VA? Sometimes people actually do their separation physicals months before they EAS, and they have time be seen for things. Do I need to tell them that they need to have a diagnosis of "shoulder pain" in their history for it to be considered documented? Of course this sometimes produces a snowball effect of them seeking appointments for knee pain, and back pain, without any intention of actually doing the physical therapy. They just want to waste your time to get things documented.

 

[j4pac]

It’s been my experience that many service members are fearful of disclosing medical details while in service...and often for good reason. Until we have a less punitive system, it’s tough to blame them. I had TONs of PTSD patients who wouldn’t disclose until right before getting out because they were fearful of getting grounded, becoming labeled, and losing their job. It’s sad when someone has to choose between getting the help they need and maintaining a livelihood. The precedence of spine pathology in those in aviation is also universal. How can I deny someone appropriate diagnostics understand epidemiology? Certainly there will be those who try to nickel and dime the system but you can’t allow yourself to be jaded by it. If and when the service member shows up on your doorstep, you can’t perpetuate the belief that medical doesn’t care about them and that your a part of the machine that’s there to silence them and ruin their livelihood.

 

[rockafella12]

It’s been my experience that many service members are fearful of disclosing medical details while in service...and often for good reason. Until we have a less punitive system, it’s tough to blame them. I had TONs of PTSD patients who wouldn’t disclose until right before getting out because they were fearful of getting grounded, becoming labeled, and losing their job. It’s sad when someone has to choose between getting the help they need and maintaining a livelihood. The precedence of spine pathology in those in aviation is also universal. How can I deny someone appropriate diagnostics understand epidemiology? Certainly there will be those who try to nickel and dime the system but you can’t allow yourself to be jaded by it. If and when the service member shows up on your doorstep, you can’t perpetuate the belief that medical doesn’t care about them and that your a part of the machine that’s there to silence them and ruin their livelihood.

You have a wonderfully optimistic view of the disability system. It's probably due to the community that you were in - aviation. Pilots and the like are pretty "high speed" and would behave like you mentioned. What I'm seeing with the "Petty Officer Schmuckatelli" types, is they will sit on the messdeck and brainstorm their way into 100% disability. The amount of 20-yr olds that demand a sleep study is really astounding. Or the "I think I need xrays for my chronic back pain".

I would also disagree with the "nickel and dime" part. Even just one Sailor getting 70% for lumbago that isn't actually disabling? That's tax money being hemorrhaged out of the system. The kids that sign up nowadays should do FSA duty in the VA system, where they can see what real veterans & disability look like.

 

[ValeRx]

I think most of this stems from the fact that your senior enlisted guys will tell everyone getting out to tell the doc everything that ever went wrong with them at your final physical. I remember being told this. Their reasoning is that the VA wouldn't approve any sort of disability if it was never documented in your military medical record.

 

[IlDestriero]

It’s not your job to be the VA disability investigator. If they complain of issues, work them up appropriately, order whatever tests you’d usually order, document what they tell you and move on. Everyone says PT before MRI, etc. in the civilian world as well, but we all know that doesn’t happen and isn’t always appropriate. It depends on what they tell you. If they claim their wife tells them they snore and have witnessed apneas, claim to be tired and unrefreshed every morning, etc. who’s to say they don’t. Who cares, order the test. They’re the ones trying to work the system, you’re just doing your job.

 

[j4pac]

It’s not your job to be the VA disability investigator. If they complain of issues, work them up appropriately, order whatever tests you’d usually order, document what they tell you and move on. Everyone says PT before MRI, etc. in the civilian world as well, but we all know that doesn’t happen and isn’t always appropriate. It depends on what they tell you. If they claim their wife tells them they snore and have witnessed apneas, claim to be tired and unrefreshed every morning, etc. who’s to say they don’t. Who cares, order the test. They’re the ones trying to work the system, you’re just doing your job.

The folklore gets passed down from generation but I don’t think the intention is to piss off doc. It’s done because there is at least a sprinkle of truth.

 

[TheTruckGuy]

So when they come in with a laundry list of things they want documented, a couple weeks before they go on terminal, what do y'all do? Do you hand back the separation physical and say "make an appointment for each thing you want to be seen for"? Or do you do the physical, write "no change to previously documented conditions, new conditions reported, but none would warrant a MEB/PEB" and say if you want to get seen for anything make a separate appointment?

An O6 doc once said "all someone has to do is 'register the complaint' prior to getting out" in order for something to be documented. Does writing it on the 2807 count? Does it need to be a chief complaint in AHLTA, or a diagnosis?

I've tried telling people to come back for each complaint, and sometimes they do, and all they really do is waste your time. They have no intention of going to physical therapy or listening to anything you say, and sometimes they'll even say they want to go to the specialist, but they show up and just tell them "I'm just here to get this documented."

 

[ValeRx]

An O6 doc once said "all someone has to do is 'register the complaint' prior to getting out" in order for something to be documented. Does writing it on the 2807 count?

As I mentioned previously, when I was enlisted and about to go on terminal, I was told to document everything on my final physical, even if I was never actually seen for it. The reason was that the VA would be able to deny anything as non-service connected if it was never mentioned in your military med record. Now this could all be just urban legend, sort of like, "all you have to do is wait 6 months from discharge for an automatic upgrade if you don't get an Honorable discharge."

 

[ValeRx]

Of course VA has their own set of rules. My final PULHES was 111211, showing a decline in hearing. This was documented in my file but I was later denied any disability for hearing loss/tinnitus because it was not service connected. Not sure how being in the infantry was NOT a service connected reason for hearing loss but hey, whatever! lol.

 

[TheTruckGuy]

Of course VA has their own set of rules. My final PULHES was 111211, showing a decline in hearing. This was documented in my file but I was later denied any disability for hearing loss/tinnitus because it was not service connected. Not sure how being in the infantry was NOT a service connected reason for hearing loss but hey, whatever! lol.

I actually hear the VA is pretty bad about about hearing loss. Makes no sense to me why they would be so strict on hearing loss, but not on sleep apnea.

I also had one Marine who went 7 years with virtually no change in hearing. Then, suddenly, on his terminal audiogram somehow does so horribly he has to go get rebaselined. He also suddenly developed GERD right before going on terminal and was trying desperately to see me for an appointment to get that documented, a couple months after I did his separation physical. The guy was such a scrawny kid, but convinced another doc he needed a sleep study (couldn't get it because of COVID).

 

[ValeRx]

I actually hear the VA is pretty bad about about hearing loss. Makes no sense to me why they would be so strict on hearing loss, but not on sleep apnea.

Which is kinda odd to be honest. I work for the VA now and when I'm looking through a chart I see some of the wildest stuff as a disability.

 

[armytrainingsir]

Ft Bliss /CRC really has this down pat when folks are redeploying.
"Oh, you have a new problem? We'll need to work that up at our pace, so no going home for you."
That said, they really tried to coax folks to complain about stuff.

 

[j4pac]

I didn’t have an overwhelming amount of service members retiring...so I kept up with all of them. As they approached retirement I would notify them and I’d get the retirement physician form out to them early so that I can anticipate everything that needed to be covered and I could appropriately ration my time. It took only a few guys with twenty complaints to realize that you can’t do everything in one visit...especially in the flight community where much is undisclosed until right before retirement. But after I got my system in place it made my life much easier and the retirees appreciated me being efficient with their time.

 

[flightdoc09]

I didn’t have an overwhelming amount of service members retiring...so I kept up with all of them. As they approached retirement I would notify them and I’d get the retirement physician form out to them early so that I can anticipate everything that needed to be covered and I could appropriately ration my time. It took only a few guys with twenty complaints to realize that you can’t do everything in one visit...especially in the flight community where much is undisclosed until right before retirement. But after I got my system in place it made my life much easier and the retirees appreciated me being efficient with their time.

What about your maintainers? They're usually the ones that get out much more frequently than the actual flyers. While they don't have the typical incentive to avoid bringing things up to medical, they still have all the gouge on what they need to say.

For me, I pretty much just ask if there's anything they haven't been seen for that they'd like to be seen for. If they say yes, and it's something super simple, I'll knock it out then. If it's not something simple I'll tell them to make an appointment for it but still do their physical. If it's something concerning (like the guy who endorses chest pain, palpitations, and fainting for the past 4 years), then I won't do the physical and start a work up for that.

My first final physical I did took me 45 minutes (it was booked for a 30 minute slot). Luckily it was my last appointment for the morning and just ate into my lunch. It was a LCpl or Cpl with 40+ things documented, including every little bug bite he ever got, the one time he spilled gasoline on his hand when filling up a humvee, and just EVERYTHING he could've possibly thought of. At that point I ready the 2807 and thought I actually had to comment on everything, and thought I actually had to do physical that checked out everything he documented. Thankfully I got some guidance from other flight docs that made things much easier afterwords. Part of the reason I started the OpMed Wiki, to pass down knowledge like this. Make everyone's lives so much easier.

 

[TheEarDoc]

I actually hear the VA is pretty bad about about hearing loss. Makes no sense to me why they would be so strict on hearing loss, but not on sleep apnea.

I also had one Marine who went 7 years with virtually no change in hearing. Then, suddenly, on his terminal audiogram somehow does so horribly he has to go get rebaselined. He also suddenly developed GERD right before going on terminal and was trying desperately to see me for an appointment to get that documented, a couple months after I did his separation physical. The guy was such a scrawny kid, but convinced another doc he needed a sleep study (couldn't get it because of COVID).

It's because hearing loss for the most part is a very objective disability to measure. If the unit is doing their tasks correctly for evaluating hearing each year then it's pretty simple for one of us in the VA to jump in DOEHRS or into VBMS and look at the service treatment record audios from MEPS through separation and if there was no significant permanent shift then there was no hearing loss per VA guidelines.

 

[TheEarDoc]

Of course VA has their own set of rules. My final PULHES was 111211, showing a decline in hearing. This was documented in my file but I was later denied any disability for hearing loss/tinnitus because it was not service connected. Not sure how being in the infantry was NOT a service connected reason for hearing loss but hey, whatever! lol.

Actually I've seen 11B's and 12B's and 12C's all have normal hearing in and normal hearing out = no hearing loss. It happens quite frequently if people wear their hearpro and don't see actual combat.

 

[TheTruckGuy]

It's because hearing loss for the most part is a very objective disability to measure. If the unit is doing their tasks correctly for evaluating hearing each year then it's pretty simple for one of us in the VA to jump in DOEHRS or into VBMS and look at the service treatment record audios from MEPS through separation and if there was no significant permanent shift then there was no hearing loss per VA guidelines.

Fair point. I have seen some separation physicals claim hearing loss, and when I look back at their old audiograms I see maybe 5dB in one range, 10 in another. Which, I guess techincally it got worse, but they make it seem like they're deaf.

But what about the people who suddenly do a lot worse on their termination audiogram? I know y'all can do a voice based audiogram that's a little harder to fake. Is that not commonly done?

I think if someone has legitimate hearing loss they should get their appropriate compensation, but I hate people gaming the system.

 

[TheEarDoc]

Fair point. I have seen some separation physicals claim hearing loss, and when I look back at their old audiograms I see maybe 5dB in one range, 10 in another. Which, I guess techincally it got worse, but they make it seem like they're deaf.

But what about the people who suddenly do a lot worse on their termination audiogram? I know y'all can do a voice based audiogram that's a little harder to fake. Is that not commonly done?

I think if someone has legitimate hearing loss they should get their appropriate compensation, but I hate people gaming the system.

Well a lot of people will try and "Fake" or "fudge" their separation audio. Happens quite frequently and I saw it quite frequently when I did the separation physicals in the VA. When they did fake I would mark the test as unreliable and then order a full hearing evaluation and then they would see an audiologist for a full eval. Faking can have some serious problems for a service member who is separating as they are not out of uniform yet and could be subject to lots of bad things.

In the military if someone fakes or fudges or even just has a significant threshold shift on their separation audio it's supposed to trigger a full evaluation by an audiologist who then will determine if the results are legit and write it up.

If someone does make it through and leaves service with a fudged or faked separation audio most audiologists who perform the compensation and pension exam can easily know through differential diagnosis if someone is not giving legit responses and often times you can get good results once the person is given an out without you coming out and telling them you know they are faking. If you get a C&P audio done outside of service and it shows no significant changes vs. their in service audiograms then the audiologist usually writes it up as such and can say they feel the separation audiogram did not show a true hearing loss and could be a possible temporary hearing loss due to say fluid, wax, poor attention to testing, etc.. A good examining compensation and pension audiologist will look at all the evidence and give an opinion based on that evidence.

 

[flightdoc09]

Actually I've seen 11B's and 12B's and 12C's all have normal hearing in and normal hearing out = no hearing loss. It happens quite frequently if people wear their hearpro and don't see actual combat.

What about air crew? Or even maintainers? I know I spend a lot of time on the flight line, and during deployment my office was a trailer just adjacent to a bunch of helicopters. Maintainers would turn on the APUs and run it for hours. Eventually I realized I needed to start wearing hearing protection. Despite being 100+ yards away, and in a trailer, I just felt like it was taking its toll on my hearing. And when I'm in the aircraft, even with double hearing protection, to the point where I can barely hear the headset, I'm still concerned about my hearing because some of that noise you just can't block out. Luckily my hearing hasn't changed that much over the past few years, and maybe the double hearing protection is working.

Another question, do you think giving air crew active noise cancelling headsets would save more hearing? I got to use some on an Air Force KC135 and I was blown away. I could actually hear what everyone was saying with virtually no background noise. I want to get something that'll work like that for when I'm on the flight line. Something to block out all the turbine engines. Any suggestions?

 

[armytrainingsir]

I want to get something that'll work like that for when I'm on the flight line. Something to block out all the turbine engines. Any suggestions?

Bose Quiet Comfort for your office and possibly outside the aircraft when on the flight line.
David Clark .mil aviation headset for use in aircraft

 

[flightdoc09]

Bose Quiet Comfort for your office and possibly outside the aircraft when on the flight line.
David Clark .mil aviation headset for use in aircraft

Thanks. I'll look into the Bose. Expensive, but I guess my hearing is worth it.

Unfortunately can't wear anything other than a poorly fitted HGU55 helmet.

 

[TheEarDoc]

What about air crew? Or even maintainers? I know I spend a lot of time on the flight line, and during deployment my office was a trailer just adjacent to a bunch of helicopters. Maintainers would turn on the APUs and run it for hours. Eventually I realized I needed to start wearing hearing protection. Despite being 100+ yards away, and in a trailer, I just felt like it was taking its toll on my hearing. And when I'm in the aircraft, even with double hearing protection, to the point where I can barely hear the headset, I'm still concerned about my hearing because some of that noise you just can't block out. Luckily my hearing hasn't changed that much over the past few years, and maybe the double hearing protection is working.

Another question, do you think giving air crew active noise cancelling headsets would save more hearing? I got to use some on an Air Force KC135 and I was blown away. I could actually hear what everyone was saying with virtually no background noise. I want to get something that'll work like that for when I'm on the flight line. Something to block out all the turbine engines. Any suggestions?

Find out who the hearing conservation officer is on your base. Ask them to come down and do noise level measurements in your trailer when they are outside working. They might have you throw on a small dosemeter for you to wear for a day or two. Then they can determine if indeed you should be protected. They might be able to do something as simple as add some acoustic foam inside the trailer. If you're wearing your double HP in the aircraft then you should be good.

Most aircraft the headsets are good. Now if you are on a C-130 well just throw on your HP and enjoy the massage chair known as the seats.....

 

[armytrainingsir]

flightdoc09,

Gonna walk back my Bose comment for flight line use. Not sure of the NRR and I can't seem to find it on their website. My guess it would be fine if you added foam plugs or even custom plugs under it.

Based on your office description, I think the noise, esp the low freq noise and vibrations you were experiencing in your office near the flight line, contributed more to fatigue, lack of concentration, etc than actual hearing damage/loss. For that, the Bose headset seems to shine, at least for me.

For use with your HGU55, you could consider exploring vented insert earphones, like here

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