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Monday, June 30, 2014

Fighting the VA – Billy’s True VA Disability Story

Billy woke up one morning to find himself, a Disabled American Veteran, trapped in a web of technicalities created by the VA Disability system. The VA only gave his condition a 0% VA Disability Rating, but he lived every day in pain from his disability. What could he possibly do to get the proxper compensation his condition deserved?

While Billy was serving on active duty, he began to develop serious skin infections that caused large, painful boils all over his body, including his head, torso, buttocks, groin, arms, legs, and feet. His physicians treated his symptoms by lancing the boils and giving him antibiotics. With this treatment, his infections would clear up, only to recur again in the future. He was officially diagnosed with “recurring abscesses”.

During this time, Billy also noticed patches of dry, irritated skin, but they were basically ignored since the infected areas were much more problematic. He noted, “These dry skin conditions could have been eczema/dermatitis for all I know, but no one bothered to call it that in my medical record. That was the unfortunate part, because this oversight still haunts me to this day.”

The only condition mentioned in his medical records, and thus the only condition eligible to receive Military Disability, was skin infections.

Billy’s first C&P Exam after leaving the military unfortunately occurred at a time when he had no obvious skin infections. He had recently been treated, the sores had all been cleared up by the antibiotics, and they had not yet come back. Because of this, the VA gave him a rating of 0% for Infections of the Skin, code 7820. 

Code 7820 is one of the conditions in the VASRD, the law that determines how conditions are rated, that is rated analogously as something else. In Billy’s case, the VA decided to rate his condition analogously with Dermatitis/Eczema, code 7806. So his final rating was Infections of the Skin rated as Dermatitis/Eczema, code 7820-7806.

Years passed. Billy’s skin infections continued coming back, and they were getting worse over time. He saw numerous doctors for treatment. One physician officially diagnosed him with dermatitis, and reported that his infections could be spreading across his body because of scratching the patches of dermatitis while sleeping. Dermatitis was now his main diagnosis.

After years of skin problems, Billy also began to develop painful and unstable scars, meaning that the scars also became infected regularly.

With his condition continually getting worse, Billy’s ability to function normally in his day-to-day life also worsened. He now definitely needed VA Disability Benefits, so he decided to contact his local VA about having his rating increased.

He contacted his local VA and filed a claim, but it was denied. The only official diagnosis he had at the time was Dermatitis, and there was no proof in his military medical records that he had had dermatitis while he was in the military. If a condition is not recorded while in the military, it is not considered service-connected and thus not ratable.

The only other way Billy could prove his dermatitis was service-connected was by providing definite proof that the dermatitis was caused by the skin infections. Unfortunately, his type of skin infections doesn’t necessarily cause dermatitis, and vice versa. Could it have, though? Absolutely, but there is no definitive proof. The VA’s loophole.

Billy tried to file VA Appeals numerous times to have his rating increased, but was always denied.

Now it may seem very clear to you and I (and I hope the majority of people) that all Billy’s skin conditions are very closely related, even to the point of being basically inseparable, regardless of what they are called. Yet, based on the laws in place, the VA denials are technically justified. Would another person reviewing his case decide that he does indeed qualify for a higher rating? It is quite possible. There are rules that the VA raters are required to follow, but there is still quite a lot left up to interpretation. Another rater may look at everything, see it as we do, and decide that he does qualify. Billy is literally being harmed by a mere technicality.

So, what can he do?  

First, he should go back to his current physician and try to get him to change the diagnosis back to skin infections. They couldn’t argue with the same diagnosis that is service-connected.

If the physician decides that his current condition is better defined as dermatitis than skin infections, then Billy should at least try to get his physician to change the diagnosis to dermatitis caused by skin infections, or something to that effect. What Billy needs to do is make it harder on the VA to say no than yes. The skin infections are service-connected, so having his doctor claim that his current condition was caused by those skin infections could be enough to sway the VA rater.

Another tool that could help influence the VA rater would be to submit images of his skin conditions with his claim. Each image should be clearly dated. If an image of his skin infections while he was in the military looks pretty close to the current images, they might agree that they are basically the same condition.

Another option would be for him to stop trying to get a better rating for his dermatitis/infections and instead focus on getting a rating for his scars. Since his scars are pretty extensive, painful, and unstable, he could get a pretty high rating for them alone. Again, though, the key to this is to have the physician claim that the scars were caused by his skin infections, not his dermatitis. Everything must link back to his skin infections in order for the VA to rate them.

All in all, Billy is in a really tough and unfortunate spot. The VA isn’t technically doing anything wrong, but Billy is definitely not receiving the disability compensation he deserves for a legit condition.

The main lesson to learn from this is to guarantee that every single condition you have, no matter how small, is properly recorded while in the military.

Service-connection is the key.

While this may not seem fair, it is actually a very good law that protects the system from being abused by the users out there. Why should taxpayers’ money go to pay for conditions that had absolutely nothing to do with military service? Military disability should be given for military disabilities.

It’s a good law overall, but it can unfortunately backfire on the honest veterans who unquestionably deserve the proper compensation.

Sadly, it may be too late for the majority of you to have their conditions properly recorded while in the military. If you are not fully separated from the military yet, though, make sure to get this done. You will definitely not regret it, and it may make all the difference in the future.

For all those stuck in the web of technicalities right along with Billy, know that you need to carefully choose your battles. There are some battles that may be easily won, but if you cannot find a way to prove service-connection, you will only be fighting a loosing battle. 

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