Introduction

“We’re here today to try and inform as many veterans as we can. We’re here with Dr. Bash. Welcome, radio land, TV land, and YouTube viewers and listeners. This is Dr. Craig Bash. I’ve been doing Veterans Medical Opinions for 30 years, and I have dozens and dozens of these radio shows, which we’re going to publish on this YouTube channel, numbered one to whatever. So thank you for listening, and here we go.

Questions for Dr. Bash

Yeah, I got a couple of questions for Dr. Bash. Go right ahead. I’ve been looking all over for about three years now, and I have a lot of veterans in my background. I’m a veteran, and they ask me many questions. In order to put together a real successful claim, I’m hearing that it’s better to have it professionally done right up front. The thing I’m finding out after all this time is that basically there’s no one out there doing DBQs and medical Nexus and that sort of thing. But Dr. Bash, if you want to smooth it through, is that true? To be successful, do you need to have all these things?

I think Skip and I have been on the TV show. You guys saw our little Bash YouTube, right? Skip, asking questions. Anyway, get to asking more questions. Yeah, the DBQ, you know, I’ve been told that for those ready-to-rate claims, if they come through and they have a DBQ, the rating, if there’s no DBQ, they won’t rate them. So the DBQ, I think, is really important. In the process, you go to the PBA. The PBA judge will remand it and ask for a DBQ on the way out, you know? So I think the DBQ is important.

Importance of DBQs

The last DBQs I’ve done, I’ve done a bunch of research on it. If you read up, I think you’ll come to the same conclusion that the DBQs are designed to go through your primary care team, and they’re supposed to fill them out. Not that someone else can’t fill them out, but if you take them to your primary care team, I think they’re supposed to fill them out for you. That’s what I did. They filled three or four of them out. Of course, it took them a while, but they got it done, and I never heard no more about them. So that’s just a suggestion. Mention it. Take them to your primary care team and have them fill them out. Ask them to fill them out. I think they’re supposed to, but if you have a doctor that’ll do it, that’s good too. But not every doctor… I had bad luck with doctors who just check a box or two, then sign it and go on. They don’t do them right.

Those DBQs are really tricky because, like for the spine one, for example, there are 177 questions, you know, one A, B, C, D, whatever. But each one of those questions kind of has volumes of laws behind it. You start talking to Bill Creger about some of those DBQ questions, and he’ll talk about court cases and general counsel opinions and precedent-setting cases. All those things can be focused on one single DBQ question. So the simple answer is not really the right answer for the DBQ sometimes. You have to be really careful who’s filling them out because it can do more harm than good sometimes.

Filing Claims Correctly

Yes, I think you’re right, absolutely. If you’re not making your claim to the full extent of everything the first time, I’ve read this, doesn’t that just go back to Washington and end up in a box with 400,000 other guys waiting for an opinion? I mean, that’s what takes seven years.

Yes, you’re right. You really need to do it right off. I’ll tell you that I’ve got a dozen friends and relatives that we’ve all tried to go to doctors and different people for help, and you can’t get them. You need to go to Dr. Bash. I haven’t found anybody else. Can you explain what CFR, U.S. Code, M21 is?

Are you talking about the Code of Federal Regulations and the M21, the VA adjudication book?

Yeah, that. In other words, you need to put all those laws in your claim too then. That would not be good for the veteran.

Higher Level of Review

Actually, can you explain a higher level of review?

Yeah, well, Skip was talking about the laws. You know, that’s something Creger talks about a lot these days. The Raiders aren’t very well trained in the rules, and the M21 is not that accurate compared to what the CFRs and what the U.S. Code is and the precedent-setting cases.

Quality Assurance Standpoint

Let me break this down from a quality assurance standpoint, dealing with the government. United States Code, Code of Federal Regulations, is the main book. It’s the main listing. Anything the VA uses as an assistance tool to do their job is based off the Title 38 CFR Part 3 and Part 4. That’s called a Level B. That’s self-written by the VA. They’ve got their own rules, but it’s supposed to actually follow the instructions issued in Title 38 CFR. That’s not always the case. Sometimes it issues where they follow the M21, which is still a government document but it’s not law. The Title 38 is law, and this is a workbook they’re using. So sometimes things get a little bit out of whack and out of sorts. That’s the quality assurance point of it. The buck stops with Title 38. If you deal with the M21, it’s not in relation to Title 38, it’s a falsehood. Sometimes that can be proven. Sometimes they’ll say, “Well, this shows you might deserve 60%, but we think it’s more appropriate to give you 40% based on this and that,” when the regulations clearly state you have this condition at 60%.

M21 and 38 CFR

So the M21 workbook is a way that can bias the law, and most veterans don’t know because the M21 says this, and the veteran thinks that’s law, and it’s not. The only way to get it fixed, like Skip was talking about, is going to the big box, to the BBA, five years down the road, and letting the BBA read the rule of law and then get it corrected.

Right, always stay with the 38 CFR. The M21 is just a reference thing. Your 38 CFR is the law, and that’s what you need to be quoting. The law says that the teaching the Raiders is based on the M21, testing them on M21, and rating the error rate based on M21 when it might not be anywhere near what the law says.

That’s true, that’s true. I mean, that’s the way it’s worded. I mean, it’s still a VA document. The M21 is still their Bible. I mean, they read that more than the Bible on Sundays in church, but it’s still a Level B. The Level B document is different than Level A. Level A always takes precedence over Level B, and that’s a quality assurance point, not in any type of law, any type of manufacturing, any type of quality system. Level A is the boss.

I think a lot of veterans are losing things because of Level B.

It can be. It is. I’ve had several arguments over the M21 because the Raider or whoever I was talking to at the VA would be quoting M21. I said, “That’s not the law. The 38 CFR is law. I don’t care what’s in the M21. It doesn’t mean anything. The law is what they should be looking at.” Of course, that’s a good way to make enemies, which I’ve got plenty of them.

Let’s put it this way. You get a claim to Veteran’s Court, you get an issue to Veteran’s Court, you go in front of the judge, and you got the Circuit Court, the Veteran’s Court. I don’t see an M21 nowhere in the building. They’ve got the Title 38 in the building. M21’s out the window.

Understanding Claims and Benefits

Yes, it is. So keep that in mind. If you have a claim, be able to reference the 38 CFR, the sections in it that you attribute to your claim. I wouldn’t pay much attention to the M21. It’s more or less a reference guide. I mean, it gives the VA Raider a chance to abuse the system, to my thinking. It shouldn’t even be there.

I’ve got a real good question for you guys. Can you explain the bottom line? I get a lot of this stuff. What is the difference if you’ve got 70% or 80% or 90% or whatever, and you’re later in life, you find that you really need more help, more money? Bottom line, how much money are we talking about between 70% and 100%? Is it worth going back?

Yes, it sure is. Between 70% and 100% is about $1,300 a month.

That’s what I’m talking about, the bottom line. In other words, the guy sitting there at 70% or 90%, if he doesn’t get help and find his way all the way to the rest of it, believe me, I know people that are really in great need of it, and they deserve it. They just outdone themselves for maybe four to five years, and they’re in need of some more help. What about their condition? Can you help them with that?

Reevaluating Claims

Skip has a good point. As people age, these disabilities get worse over time, and so they really should go back and have their whole thing relooked at. Secondary complications, maybe medication effects, and that can have a big effect on your percentages. The difference between 70% and 100% is a huge amount of money. Once you get to 100%, you’re eligible for SMC awards above that. All those things can be increasingly worse over time as you age. I recommend every five years or so, go back and get the whole thing relooked at, reanalyzed, make sure that your claims are accurate.

Need for DBQs and Nexus Letters

Do you need new DBQs or Nexus or anything like that? Do you need a full redo on it?

Yeah, yep, look at it, and you need to state the laws in there. Remember, the VA, the way they operate, it doesn’t matter if you’re service-connected for a condition. They’re going to look at that condition, they’re going to compare your current condition to the old condition. Has that condition worsened over time, which most of them do? But they don’t add it on. What they do is start a new process. So it’s like you’re filing the claim all over again. You go through the CMP exams and everything for the increase. Everything’s treated as a new claim.

Documentation and Record-Keeping

Everything’s treated as a new claim. That’s how they do it. Even if you add a dependent, it’s treated as a new claim.

So we’re back to that “How to Succeed in 2019,” you know, DBQs, lay letters, testing, medical evaluations. You got to have everything lined up consistently. That’s a good question, Skip, because we have a lot of veterans like that who are sitting at 60%, 70%. Some of them are afraid to tackle the VA because they don’t want to lose what they have or they don’t know how to do it or what to do. The rules are all changing, and they’re not sure how to interface with it.

Can you make any recommendations for those of us that are not up to date on it? I get a lot of questions and ideas from everyone.

Tips for Filing Claims

The best thing to do is always make sure you got a copy of your C file, make sure you got access to E-Benefits, make sure you got a copy of your complete medical record. Look at all your testing you’ve had and things like that. For example, heart disease. Say you, ten years ago, got a 60% rating because you got an ejection fraction of 50%, 49%, 48%. Say ten years down the line, you start getting short of breath, and you go have a heart cath done, and you look up and your ejection fraction is 28%. That’s a 100% rating. Heart conditions, lung conditions, things are going to kill you. A knee condition is not going to kill you, but anything functional like your heart and your lungs and things like that can put you in the ground. Those are the worst ones because if you’ve got one condition, as you get older, they’re going to get worse. That’s just a fact of time. Those claims are a lot easier to win because it is what it is. I mean, you got a heart cath with an ejection fraction reading of a certain percent, they cannot deny it because you’re already service-connected for it anyway.

Getting Help

Also, these veterans need access to you guys. Other than research and everything, I’d like to hear how you get in touch with any of you guys.

You can find me. You can go to hadit.com. It’s an excellent website, and they cover about every category there is.

How about to direct me to Dr. Bash? He’s making some good information.

Oh yeah, I’m on the web. Google Craig Bash, www.veteransmedadvisor.com, and that’s a good way to find me, email, and…

Skip makes a good point there. Besides getting an increased rating, it also affects people’s medical care because you go to the medical record, the VA, you see the 100% rated for the heart, for example, like you were talking about. It gets the attention of the nurse practitioner and the PA, you know, that this guy’s got some serious heart disease. So people pay attention to the record more, I think, when it’s rated higher.

Lowball Ratings and CUE Claims

Remember that a lot of times the VA will lowball you, give you a lowball rating. If you know to look in your 38 CFR and you’re, like John was mentioning, your EIC, heart disease, and pulmonary hypertension, if your pressure is so much, you’re entitled to some, you know, you should have this rating. If you see that you’ve been lowballed, you can come back and cue the VA and say, “Hey, you guys gave me a low rating according to the CFR, paragraph such and such section.” You need to be able to look at it in the 38 CFRs.

Specific Medical Conditions

Here’s a good one, Dr. Bash. I’ve known several veterans that were service-connected for like COPD or restrictive lung disease, interstitial lung disease, any of the lung diseases. Later on in life, they had heart issues. They went to a heart cath, and they got reading their heart cath information. Of course, a lot of vets don’t know how to do this. You need somebody in the family that knows a little medical stuff, an RN or anybody that can help you. So if you look at your heart cath and you see your ejection fraction is pretty decent, but you get down the heart cath, you look at your pulmonary artery pressures, and it’s, say, if it’s 30, 33, you’ve got pulmonary hypertension. That’s an automatic 100% disability. Is that okay?

Yeah, yeah, a lot of veterans don’t know that. Pulmonary hypertension is a big deal. It’s a very devastating disease, and it can be secondary, like you talk about. A lot of inhalational stuff, veterans breathe in the dust and smoke pits and whatever else gets in their lungs, and it can cause that inner system to get thick, and then the pressures go up. The problem is that’s kind of a… There are some subtle findings on chest X-ray that a radiologist can pick up on, but you need one of those heart caths, and not everybody gets a heart cath all the time. So they’ll have a lot of cardiopulmonary problems and symptoms, and they won’t necessarily… The echo will show it.

Yeah, yeah, some of those tests people don’t get right off the bat. There’s a lot of veterans out there that have that and don’t know it.

Contact Information

Hey, Dr. Bash, can you give your email address for Skip?

Okay, it’s jbacher@metronet.net.

Where is it?

Metronet. MyMetronet.net.

Oh, MyMetronet. It’s the gigabyte internet service.

For everyday veterans, you can call me. I’ve answered a lot of questions over the last three years, and I thank you all. Got a 925. I’m in California, but I’m talking to Iraq and Marshall Islands, Guam, and all over the world. But anybody who wants some help, I’ll be glad to answer anything I can. That’s 925-381-7561.

Skip, shoot me an email for all you do. Great information. Shoot me an email after a while, we’ll talk a little bit.

Concluding Remarks

Thank you all. Right on.

But folks, Dr. Bash, any other points you want to make to be successful in 2019?

Like the VA grouping claims, if you see a grouped claim, you know, spine, neck, and knee together, ask somebody to split it out because the VA is grouping all these claims and really cutting back on the benefits that way.

No grouping claims.

Yeah, if you catch that, folks, nip it in the bud. As Barney Fife says, you got to put a stop to it because Title 38 CFR didn’t group them, so why should the VA group them?

No, no grouping.

It tells you what’s what. That’s my advice to anybody. You go online to access that, type in Title 38 CFR Part 3 and Part 4 if you want to know more about the disability process and how they rate. Look at Part 4, it goes into every aspect. If you want to know how they rate and why they rate, go to Part 3. Start from the top and go to the bottom. It’ll take you about three months to read it and understand it, but it’s very well worth it. It’s a good read until you get to the part on Special Monthly Compensation. Then you just scratch your head, take your shoes off, and wonder what happened.

That’s a whole subject for another two-hour show.

About our world expert in CFR SMC.

Acknowledgments

Well, we’re very fortunate, Dr. Bash. You are too, to have that man as an assistant or advisor because I’ve been doing this business for a long time, and he’s probably one of the most knowledgeable people I’ve ever talked to dealing with the VA. I’ve been doing this for a long time.

Yep, and he’s a very valuable person to have on the team.

Thank you, Skip, for all your help and educating us.

Thank you for the show. He’ll come back. He just had a little bit of surgery, but he’ll be back. Veterans have questions, always feel free to ask them on the radio. We’ll try to answer.

Contact Information and Closing

Okay, well guys, now you guys know how to get a hold of Dr. Bash. It’s DrBash.com. If you want to get a hold of me, you can go to hadit.com. You can look up J Basher and send me a private message. You can also look up Gerald, it’s just JR. Send a message on Hadit if you need any information like that. If you really want to get involved with Hadit, go ahead and register for the site and get in the forums. Then if you can get on the forums, shoot me a message saying you joined the site, and I’ll get on and get with Tberg. We’ll run some red tape and get you into the forum and help you out as much as we can. There are about 19,000 veterans on Hadit, and there’s a lot of them that like giving back and helping. So there’s a lot of people that’s probably got the same condition other veterans do, and it’s kind of like word of mouth, grassroots, you know, “How did you do this? How do you do that?” Here’s what I did and here’s how I did this. That’s what Hadit is all about.

Thank you all for listening. That ends this show. Now I’m going to zoom off.”