Fighting the VA ~ Our "other" job ~ Part 2

Other than help my husband navigate the world each day, I have to find out how to take care of our family. I've been handed a husband who can't provide for us and many civilians think that the military or the VA just "takes care of everything" with a POOF! I'm sorry, but it's nobody's job to take care of us. It is not the military's job to care for wounded soldiers' families. There is no division of the military that is assigned to the caring about a soldier's future. The VA is the agency that takes that on, but even then, there are two sections of the VA and they don't communicate with each other. Aside from all the bureaucratic levels of mess that exist, there is also nobody to train anyone on how to navigate through it! Wives or family members of these wounded soldiers have to just figure it out.

The purpose of this post is to give a little overview of what I've figured out.

The VA has two parts: the VBA (Veterans Business Administration) who is in charge of ratings and compensation and the VHA (Veterans Health Administration) who is in charge of treating your illnesses and injuries. When a soldier is hurting and he's sent to the VA, he goes to the VHA, the doctors who will run tests and write things down and prescribe medicines and recommend him to other departments for treatments. They give opinions on how injured a soldier is and try to predict how these injuries will affect the soldier's livelihood and relationships, but none of this will pay the bills. It's the VBA that a soldier needs to contact in order to have his medical records looked at for them to determine the meaning of those predictions. They will decide how disabled from working that soldier is. A soldier cannot just call up the VBA and talk to someone  and bango it's good to go. The soldier has to find a VSO (Veterans Service Officer) to contact the VBA through the process of filing a claim. For each injury a soldier has a claim must be filed. A VSO's job is to know what injuries are claimable based on the book of codes the VBA uses to determine disability. In my husband's case, his injuries are so bad that he could never understand what I've just explained! This is all my job.

Not all VSO's are good ones and all VSO's are very busy with large caseloads. It will behoove you to know what your VSO knows so you can help things along. If you don't, then your family's well-being and your future is left up to a guy who is really busy and might not know very much. You could end up waiting a year or more only to have claims denied because your VSO didn't know what he was doing. I am not that kind of wife, I will not leave my families well-being and our future up to a guy in some office!

There is a book of codes that can be found on the internet called e-CFR (electronic code of federal regulations). Title 38: Pensions, Bonuses, and Veterans' Relief has a Part 4 - Schedule for Rating Disabilities that itemizes the rules the VA uses to determine ratings. In these rules you will see how they define the severity of an injury and how that equates to a percentage.

38 eCFR Part 4

I familiarize myself with these codes so that I can make sure the VHA (i.e. doctors) writes the correct wording for the VBA to recognize easily. The doctors don't know what this book of codes says and so it makes it difficult when the soldier awaiting a decision from the VBA has to hope the VBA sorts through hundreds of pages of medical records and comes to an accurate conclusion and a fair rating. Regarding Dean's TBI, if I didn't know the scale they used to rate it, I wouldn't know what they are looking for and I wouldn't make sure they got brought up. If we don't bring them up then they won't get written down and without them in the medical records, the VBA can't find evidence of it.

Another reason reading these codes is helpful is so that we don't waste time wanting higher ratings for things that don't rate higher or claiming injuries that they don't rate. An example of this is Dean's broken vertebrae. This injury is not a claimable injury. There is no rating for it because it is healed and does not stop Dean from working. So even though it was a service connected injury, that is not how the VA works. Other examples: Tinnitus - no matter how bad it is, they don't rate it higher than 10%; Migraines - no matter how bad they are or if they occur everyday, they don't rate it higher than 50%. These are helpful things to know so you don't waste your energy and time being exasperated over things being the way they are.

There is another link in this process. Once you get a VSO to file the claims for the injuries that have been tested, documented, and treated by the VHA, you will be scheduled for a C&P exam (Compensation & Pension). A C&P exam is when the soldier has to go to an exam by what I like to call the "insurance adjuster" type of doctor. It is this doctor's job to judge how true your claim for injury is and how severe it actually is. It is their job to see if a soldier is faking an injury or embellishing his claim. It's this doctor's job to try and save the VA from having to pay so much. These doctors are often not friendly and they will tell you that they are not there to help you get treatment or give you medicine.

Once a soldier has the C&P exam those documents are put in a big file along with medical records and evidence that must be provided by the soldier (i.e. sworn statements, letters from wives and family members, military documents, etc). Then the VBA can make a determination of rating based on their CFR. A rating equates to a dollar amount and that's how a soldier is compensated for his disability. Of course there are many soldiers that get an unfair rating decision and they have to appeal, but without reading the CFR they won't know what is fair and what's not fair.

I hope this has cleared some things up about what soldiers and sometimes their caregivers have to go through to get VA compensation. Please ask away if you have any questions :)