Veterans' Advocate Jim Strickland answers questions from VA Watchdog dot Org readers.

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Veterans' Advocate Jim Strickland provides regular columns for VA Watchdog dot Org.  If you would like to contact Jim about his columns, you can email him here...  The archive of Jim's articles is here...  To find an answer to a specific VA benefits question, use the VA Watchdog search engine... click here...  And, be sure to use Jim's:  "A to Z GUIDE OF VETERANS DISABILITY COMPENSATION BENEFITS" click here...  JIm's series for new vets, "Welcome Home," is also featured on Military.com. And, you can follow Jim on TWITTER here ...

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by Jim Strickland

NOTE:  Letters in my Q&A columns are reprinted just as they come to me. Spelling and grammar are left as is and only small corrections are made to improve readability, ensure anonymity or delete expletives that may offend some readers. This is not legal advice. You should always seek the advice of an attorney who is qualified in Veterans' law before you make any decisions about your own benefits.

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... before we get to readers' letters ...

Back to The Basics, it's All About the Evidence

The VA requires reasonable proof that any claim you make is factual. This isn't an untenable obligation or burden on the veteran when applied fairly.

The evidence your VA likes to see most of all is what I refer to as The Golden Thread.

The Golden Thread begins with an event in service (or known before service and aggravated by service) that causes a condition. It ends at the successful award of a deserved benefit. The Golden Thread must remain unbroken.

The original event (for example, an injured knee) is noted in some official record and treated medically. Whether treatment is minor or major is of little consequence, that the event itself has been recorded is the critical action and begins the thread.

The thread must then go on unbroken. The condition precipitated by the event (that hurt knee) must continue to be a bother to the injured person. Ideally, the person will seek medical attention because the condition is disabling to some degree. That medical attention should be recorded, and the thread goes on.

As before, the degree of medical attention or disability isn't important in the Golden Thread, only that there is some record of the continuity of the original injury.

Eventually there is a completion of the person's military service obligation and an honorable discharge...ETS. The thread continues with an exit exam that would note that the individual has sought attention to the knee during active service. Whether there is a disability rating assigned at ETS isn't particularly important.

Within a reasonable period of time after ETS, to continue that Golden Thread unbroken, the veteran will seek attention from a health care professional regarding the original injury. Ideally, the first contact will be within one year of ETS.

And so it goes up to the point of making a formal claim for service connected disability compensation benefits with your VA.

The thread must have continued unbroken. Regularly recorded visits with professionals to treat the condition keep the Golden Thread intact.

The reality is that should the veteran go 2 or 3 years without a treatment record of that original injury, the claim isn't likely to succeed without an appeal. If there is no record at all of the veteran being treated for a decade or more after ETS for a condition claimed as service connected, it's a sure bet that the claim will be denied and probably won't survive appeal either.

This is particularly true of joint conditions. Whether of the neck, the spine, knees, hips or shoulders, as we age we can all have x-rays done that show degenerative changes. This is a normal part of the process of getting older and can't be assigned to routine military service.

Without the Golden Thread, denial of the claim is often swift in coming. The usual first argument that veterans want to make when they are denied is, "I was in pain for 25 years after that injury but I toughed it out until now. I didn't have time to go to a doctor and keep records of my pain, I was busy working."

The veteran may also submit "buddy letters" from friends or family who have known them for a long time and who will attest that the veteran complained of pain or disability because of that condition. As a rule, VA doesn't consider those statements as credible because the witnesses have no first hand knowledge of the original event and no particular medical expertise.

If you have some record of an event in your military service, whether it's back strain, neck strain, a sore joint or a pulled muscle, that isn't enough to establish that you have developed a chronic disabling condition because of that event.

If you had an event and sought medical care once or twice but nothing beyond that, you're going to have a very steep uphill climb to prove that the event then is the reason for your disabling condition today.

Time is not on your side. If it's been a decade or two or three since your event but now you need the money so you're going to file for it, think twice before you do.

If you can't plainly see the Golden Thread with your own eyes, the VA won't see it either. Save yourself a lot of angst and save the VA some time and take a pass on filing a claim you aren't going to win.

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Jim;

Got an idea, wanted to see what you think about it and then you might want to pass it on. In the last couple of months I have missed VAOPC appointments that I was not aware of (unusual because as soon as I get home I write my next appointment on the calendar). On the first of each month I have started calling the number listed on my medications for the VAMC where I am assigned for health care. It is an automatic recorded system so I am not tying up the services of a live individual. I choose the option to hear about upcoming medical appointments and then check these against the calendar.

If I remember correctly, my last C&P was also scheduled this way. If a vet was awaiting his C&P he could use this to check for an appointment and then not miss it by being unaware of it. Mail does get lost after all, I choose not to believe that VA intentionaly does not notify vets about these appointments with the intention of making them miss their appointments. What do you think?

Reply;

I think VHA may call you a hero for your efforts to get to your appointments on time.

Did you know that missed appointments is one of the biggest expenses VHA has? In terms of productivity, it's millions of dollars a day. Every time a veteran misses an appointment it will need to be rescheduled. With hundreds of thousands of us attempting to get in the doors every day, it's a miracle any of it works.

This isn't just a VA problem. Have you ever noticed that some civilian doctors and dentists will charge you a fee if you miss an appointment without some advance notice? It's lost time and lost revenue to them. At VA it's time that could have been spent with another veteran.

It's incumbent upon us all to do what we can to stay current with our appointments. If the VHA makes an error, so be it...we can make that system better by working with them.

Thanks for sharing your tips,.

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Jim;

Reading some of the forums, I get a lot of negative info such as the VA always denies even valid claims, and makes you take it to appeal, basically to collect the interest on the money while it sits there for the duration. What is your opinion on this? I hate to think that we file this claim, get all the evidence to them including the nexus letters, and end up in the appeal process anyway.

I’ve read all you advisory sites, and followed your advice to the best of my ability, hoping to not have to go to appeal. Also, does everyone go to the C & P exam? Anything that you could add to calm the nerves? I filed my claim in July this year, sent all my evidence, know that all my medical has been requested and sent, have 3 doctors’ nexus letters. Now what? I sure could use your imput! Thank You

Reply;

I estimate (unscientifically, it's my personal observation) that 70% of all applications must be appealed. The work by the VA is so sloppy at first pass that the majority of decisions are deeply flawed and unacceptable. A denial and an appeal is just one more step in the process.

I don't believe it's got anything to do with interest building up, this is government money after all. It's more that the VA is not doing the job very well and they can't get it right.

This is even when your application is perfect. The reviewer is so pressed for time (they work on quota) that they don't have the opportunity to do a good job. Their work isn't critiqued for quality or accuracy, only for details that allow the file to be closed and moved off the desk.

Although a C & P exam is not mandatory by regulation, everyone gets one. The subcontractor that does the C & P examinations (those aren't VA employees) is staffed at the executive level by ex-VA Secretaries. The more C & P exams, the more money they make. The good ol' boy network is alive and well at your VA.

There's no reason to dread the C & P exam. The examiner is not the person that makes the decision. The examiner will only write out a report and it too is very likely to be full of mistakes. I appeal many cases on the basis of an inadequate examination.

Don't get me wrong...when I report all this to you I'm not angry or bitter about it, I'm just telling you how the system works. The process at VA is broken badly and it's a shame but it's what we have to deal with.

I've recently published a guide that should help you understand what you're dealing with.

Click here http://jimstrickland912.com

and do yourself a huge service by spending some time learning the details of how all this works. There's an entire section in there about C & P. Please read the home page and then "The Dirty Dozen" first. That will explain a lot.

Knowledge is power and you'll feel a lot better about the ordeal when you begin to understand and accept that you aren't doing it wrong, the VA is.

Of course, I'm always here for questions that aren't answered in my A to Z Guide.

Thanks for reading...and thank you for your service to our country.

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Jim;

I just spent some time searching and reading your Q&A's. Wow, you do great work.

I recently had an appointment at VA Dermatology clinic located some miles away from the VAMC in Gainesville, Florida. After the appointment, when I went to the VAMC travel section to get travel pay I questioned the amount that had been calculated and explained that I had traveled to the Dermatology clinic and not the VAMC. I was told that it was all the VAMC and they paid zip code to zip code and that was it. I asked to see a supervisor and was told that they were all in a meeting.

I then went to the Patients Advocates office and talked to one of the advocates. She said she would phone me with an answer.
Upon returning home I researched The VA FAQs at: http://www.va.gov/healtheligibility/library/faq
s/benetravelfaq.asp#mileage 
Question 13 says: How do we determine mileage for reimbursement purposes?

The answer says:
VA has not established use of a single reference. Mileage can be determined using authoritative guidance such as Rand McNally or MapQuest; or zip code to zip code as determined at the local VA health care facility, whichever gives the greater benefit to the veteran. (emphasis mine)

The Patients Advocate phoned me and I pointed out the VA FAQ and she said that was not the regulation and she would get back to me with the regulation or directive. Still waiting for the reference.

Then I looked through the CFR 70 series for an hour or more and found no reference to how the mileage is figured. I looked at Part 70 - VHA Beneficiary Travel Under 38 U.S.C. 111 and found no reference as to how the mileage is figured. I then unsuccessfully tried to search VA Fast Letters and finally your Q&A's. I wonder if there even is a directive that covers calculation of travel mileage.

Any ideas?

Reply;

Thank you for your service to our country sir!

You're chasing an age old argument that doesn't have any good answers. I'm not sure how you define, "some miles away from the VAMC in Gainesville" but I question whether the chase is worth your time?

I've looked at this time and again and I discover the old, "It's always been done that way..." sort of attitude. I'm pretty ambivalent since the base rate was raised a short time ago...a couple of bucks here and there for a trip to the quack doesn't bother me too much. I figure I have (x) amount of time and there are (YZ) numbers of battles that need fighting with VA so I'm careful which fights I put my dogs into.

I went to the dermatologist a couple weeks ago and I travel from outside Savannah up to Charleston, SC VAMC. I ride my Hog at about 45 MPG and I collect $97.00 and change. I know civilians in the Palatka area that go to Shands in g-ville to see specialists and don't get anything but a long ride for their trouble.

If this one really troubles you...and I'm not saying you're wrong if it does...you should begin with your Congressperson to re-define applicable laws. He or she would write the bill, seek co-sponsors and pass it to the Senate...the usual legislative path. It's how we forced VA to allow us to use lawyers back in 2007. The system works, clumsy as it is.

Choose your battles carefully. Remember the VA has no feelings, it isn't a sentient being, time is meaningless there.

Words to live by...

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

On the other hand, go kick some ass and take some names if that's what floats your boat. I take on "hopeless" cases every day and I don't stop to think about it much, I do what I think is right and that ends the debate for me.

Here's the law for you to enjoy;

TITLE 38, PART I, CHAPTER 1, § 111. Payments or allowances for beneficiary travel;

(a) Under regulations prescribed by the President pursuant to the
provisions of this section, the Secretary may pay the actual necessary
expense of travel (including lodging and subsistence), or in lieu
thereof an allowance based upon mileage traveled, of any person to or
from a Department facility or other place in connection with
vocational rehabilitation, counseling required by the Secretary
pursuant to chapter 34 or 35 of this title, or for the purpose of
examination, treatment, or care. In addition to the mileage allowance
authorized by this section, there may be allowed reimbursement for the
actual cost of ferry fares, and bridge, road, and tunnel tolls.
(b)
(1) Except as provided in subsection (c) of this section and
notwithstanding subsection (g)(2)(A) of this section or any other
provision of law, if, with respect to any fiscal year, the Secretary
exercises the authority under this section to make any payments, the
Secretary shall make the payments provided for in this section to or
for the following persons for travel during such fiscal year for
examination, treatment, or care for which the person is eligible:
(A) A veteran or other person whose travel is in connection with
treatment or care for a service-connected disability.
(B) A veteran with a service-connected disability rated at 30 percent or more.
(C) A veteran receiving pension under section 1521 of this title.
(D) A veteran
(i) whose annual income (as determined under section 1503 of this
title) does not exceed the maximum annual rate of pension which would
be payable to such veteran if such veteran were eligible for pension
under section 1521 of this title, or
(ii) who is determined, under regulations prescribed by the Secretary,
to be unable to defray the expenses of the travel for which payment
under this section is claimed.
(E) Subject to paragraph (3) of this subsection, a veteran or other
person whose travel to or from a Department facility is medically
required to be performed by a special mode of travel and who is
determined under such regulations to be unable to defray the expenses
of the travel for which payment under this section is claimed.
(F) A veteran whose travel to a Department facility is incident to a
scheduled compensation and pension examination.
(2) The Secretary may make payments provided for in this section to or
for any person not covered by paragraph (1) of this subsection for
travel by such person for examination, treatment, or care. Such
payments shall be made in accordance with regulations which the
Secretary shall prescribe.
(3)
(A) Except as provided in subparagraph (B) of this paragraph, the
Secretary shall not make payments under this section for travel
performed by a special mode of travel unless
(i) the travel by such mode is medically required and is authorized by
the Secretary before the travel begins, or
(ii) the travel by such mode is in connection with a medical emergency
of such a nature that the delay incident to obtaining authorization
from the Secretary to use that mode of travel would have been
hazardous to the person’s life or health.
(B) In the case of travel by a person to or from a Department facility
by special mode of travel, the Secretary may provide payment under
this section to the provider of the transportation by special mode
before determining the eligibility of such person for such payment if
the Secretary determines that providing such payment is in the best
interest of furnishing care and services. Such a payment shall be made
subject to subsequently recovering from such person the amount of the
payment if such person is determined to have been ineligible for
payment for such travel.
(c)
(1) Except as otherwise provided in this subsection, the Secretary, in
making a payment under this section to or for a person described in
subparagraph (A), (B), (C), or (D) of subsection (b)(1) of this
section for travel for examination, treatment, or care, shall deduct
from the amount otherwise payable an amount equal to $3 for each
one-way trip.
(2) In the case of a person who is determined by the Secretary to be a
person who is required to make six or more one-way trips for needed
examination, treatment, or care during the remainder of the calendar
month in which the determination is made or during any subsequent
calendar month during the one-year period following the last day of
the month in which the determination is made, the amount deducted by
the Secretary pursuant to paragraph (1) of this subsection from
payments for trips made to or from such facility during any such month
shall not, except as provided in paragraph (5) of this subsection,
exceed $18.
(3) No deduction shall be made pursuant to paragraph (1) of this
subsection in the case of a person whose travel to or from a
Department facility is performed by a special mode of travel for which
payment under this section is authorized under subsection (b)(3) of
this section.
(4) The Secretary may waive the deduction requirement of paragraph (1)
of this subsection in the case of the travel of any veteran for whom
the imposition of the deduction would cause severe financial hardship.
The Secretary shall prescribe in regulations the conditions under
which a finding of severe financial hardship is warranted for purposes
of this paragraph.
(5) Whenever the Secretary increases or decreases the rates of
allowances or reimbursement to be paid under this section, the
Secretary shall, effective on the date on which such increase or
decrease takes effect, adjust proportionately the dollar amounts
specified in paragraphs (1) and (2) of this subsection as such amounts
may have been increased or decreased pursuant to this paragraph before
such date.
(d) Payment of the following expenses or allowances in connection with
vocational rehabilitation, counseling, or upon termination of
examination, treatment, or care, may be made before the completion of
travel:
(1) The mileage allowance authorized by subsection (a) of this section.
(2) Actual local travel expenses.
(3) The expense of hiring an automobile or ambulance, or the fee
authorized for the services of a nonemployee attendant.
(e) When any person entitled to mileage under this section requires an
attendant (other than an employee of the Department) in order to
perform such travel, the attendant may be allowed expenses of travel
upon the same basis as such person.
(f) The Secretary may provide for the purchase of printed reduced-fare
requests for use by veterans and their authorized attendants when
traveling at their own expense to or from any Department facility.
(g)
(1) In carrying out the purposes of this section, the Secretary, in
consultation with the Administrator of General Services, the Secretary
of Transportation, the Comptroller General of the United States, and
representatives of organizations of veterans, shall conduct periodic
investigations of the actual cost of travel (including lodging and
subsistence) to beneficiaries while traveling to or from a Department
facility or other place pursuant to the provisions of this section,
and the estimated cost of alternative modes of travel, including
public transportation and the operation of privately owned vehicles.
The Secretary shall conduct such investigations immediately following
any alteration in the rates described in paragraph (3)(C) of this
subsection, and, in any event, immediately following the enactment of
this subsection and not less often than annually thereafter, and based
thereon, shall determine rates of allowances or reimbursement to be
paid under this section.
(2) In no event shall payment be provided under this section—
(A) unless the person claiming reimbursement has been determined,
pursuant to regulations which the Secretary shall prescribe, to be
unable to defray the expenses of such travel (except with respect to a
person receiving benefits for or in connection with a
service-connected disability under this title, a veteran receiving or
eligible to receive pension under section 1521 of this title, or a
person whose annual income, determined in accordance with section 1503
of this title, does not exceed the maximum annual rate of pension
which would be payable to such person if such person were eligible for
pension under section 1521 of this title);
(B) to reimburse for the cost of travel by privately owned vehicle in
any amount in excess of the cost of such travel by public
transportation unless
(i) public transportation is not reasonably accessible or would be
medically inadvisable, or
(ii) the cost of such travel is not greater than the cost of public
transportation; and
(C) in excess of the actual expense incurred by such person as
certified in writing by such person.
(3) In conducting investigations and determining rates under this
section, the Secretary shall review and analyze, among other factors,
the following factors:
(A)
(i) Depreciation of original vehicle costs;
(ii) gasoline and oil costs;
(iii) maintenance, accessories, parts, and tire costs;
(iv) insurance costs; and
(v) State and Federal taxes.
(B) The availability of and time required for public transportation.
(C) The per diem rates, mileage allowances, and expenses of travel
authorized under sections 5702 and 5704 of title 5 for employees of
the United States.
(4) Before determining rates or adjusting amounts under this section
and not later than sixty days after any alteration in the rates
described in paragraph (3)(C) of this subsection, the Secretary shall
submit to the Committees on Veterans’ Affairs of the House of
Representatives and the Senate a report containing the rates and
amounts the Secretary proposes to establish or continue with a full
justification therefor in terms of each of the limitations and factors
set forth in this section.
(h) The Secretary, in consultation and coordination with the Secretary
of Transportation and appropriate representatives of veterans’ service
organizations, shall take all appropriate steps to facilitate the
establishment and maintenance of a program under which such
organizations, or individuals who are volunteering their services to
the Department, would take responsibility for the transportation,
without reimbursement from the Department, to Department facilities of
veterans (primarily those residing in areas which are geographically
accessible to such facilities) who seek services or benefits from the
Department under chapter 17 or other provisions of this title.

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TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, Jim Strickland, Veterans' Advocate,