Vetsclaimappeals
CESSATION OR CONTINUANCE OF DISABILITY
BOARD OF VETERANS APPEALS (findings) Docket: 81-16-411
PAGE #s Dated: 5.10.79 1
Dated: 9.8.81 2 - 4
DEPT. OF VETERANS AFFAIRS Reg: 343/213/mdv
Dated: 5.22.87 6 - 7
Dated: 3.11.99 8
DEPT. VA MEDICAL (periodically review)
Dated: 4.27.04 17
Dated: 5.10.04 18
VA REQUEST FOR OUT PATIENT SERVICE
VA MEDICAL NOTICE TO HAND & FOOT DOC.
Dated: 7.10.04 21 Dated: 7.28.04 22
Dated: 7.30.04 24 - 24
RATING PRACTICES & PROCEDURES Dated: 3.17.80 100 -102
LAW CODES: DEPT. VA
(exhibit J-2)
(exhibit M & M-2)
103
104 - 105
THE ISSUE
i. Entitlement to a temporary total disability rating based on hospitalizacion frea September 25, 1979, to October 17, 1979.
2, Entitlement to a temporary total disability rating based on hospital-ization from November 26, 1979, to May 16, 1980.
3. Entitlement to an increased rating for schizophrenic reaction, latent type, evaluated as fifty per cent (50%) disabling.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of the United States
CONSULTATIONS BY THE BOARD
Robert E. Sullivan, Staff Legal Adviser
ACTIONS LEADING TO PRESE APPELLATE STATUS
At the informal hearing, the veteran's accredited representative raised the issue of entitlement to service connection for post traumatic stress disorder and entitlement to a total rating based
upon individual unemployability. Such issues have not been properly developed or certified for appellate review and they are returned to the agency of original jurisdiction for appropriate disposition.
REMAND
The veteran had active service from August 1969 to August 1973. Our review of the pertinent clinical data of record shows that
complete clinical documentation with respect to the periods of
hospitalization irequest are attocurrerepresentation Atcorrespondence ddirected, en-
the evidence now case be REMANDED
available, it is the decision of for the following action:
complete clinical records of the veteran's of hospitalization from September 25, 1979,
2. The veteran should be accorded a complete psychi-atric examination to include all indicated tests,
in particular, to determine the nature and extent of
The claims should be made
been completed, the claim should be reviewed jurisdiction. If the determination continue
Dear Senator Jackson:
cision and a subsequent decisi evaluation while hespitalized.
service-connected nervous » Mr. Ojala
denying a 100 percent
On September 1, 1982, the Beard of Veterans Appeals granted his claim for a temporary 100 percent evaluation during his perieds of hespitalization, but denied an inerease in bis present 50 percent evaluation.
Award action was taken on October 19, 1982 to authorize Hr. Gjale the 100 percent rate for his perieds of hespitalization from September 25, 1979 to November 1, 1979, from November 26, 1979 to June 1, 1980 and from September 22, 1981 to December 1, 1981. He remains evaluated as 50 percent disabled when not hespitalized. He will receive a retroactive payment of $6480.55 in the near future.
Youx imterest on behalf ef Mr. Ojala is appreciated.
Sincerely yours,
RICHARD F. MURPHY Director
MAY 22 1987
Mr. George P. Ojala Route 1, Box 20 Copenhagen Road Leleta, CA 95551
Your April 29, 1987, letter with enclosures to the President
concerning your claim for veterans' benefits was referred to
me for response. In view of your request for reconsideration of a decision by the Board of Veterans Appeals, I asked Kenneth E. Eaton, Chairman of the Board, to review your correspondence and provide me with a report.
M Eaton advised me that following an examination in 1978, the regional office decreased the evaluation of your service-
connected schizophrenic reaction from _70 percent to 50 percent effective from April 1, 1979, and also discontinued your total. rating based upon individual unemployability, effective March . You appealed this action and in September 1982, the Board determined you were entitled to 100 percent evaluations for two periods of hospitalization, but entitle-ment to a schedular evaluation in excess of 50 percent for
your schizophrenia was denied.
In the latter part of 1982 your claim was reopened and addi-tional evidence was received. In December 1984 the regional
office determined you were entitled to 100 percent evaluation
for chronic post-traumatic stress disorder, previously diag-
nosed schizophrenic reaction. The increase was effective from
August 28, 1984, the date of a psychiatric evaluation con-ducted at the University of California. This rating action
was appealed and on December 17, 1985, the Board held that an
effective date earlier than August 28, 1984, for assignment of
a total rating for chronic post-traumatic stress syndrome was not warranted. In their decision, the Board Members related
that they carefully reviewed all the evidence of record in
connection twith tthe mprevious nBoard adecision s(Septembere1982) e
adequately supported by the evidence then of record.
From reading the correspondence you sent to the Board, it is
apparent you feel you are entitled to a 100 perc
prior to tAugust h28, o1984. dMr. sEaton tconsideredcthis, buason-
ably supported wby gthe g evidence. uaHe omentionedetha does not
create oreversible lerror iand whe ldid anot nidentify tion of either decision
Rating Decision NAME OF VETERAN
epartment of Veterans Affairs 03/04/99 VA FILE NUMBER ‘SOCIAL SECURITY NR
ISSUE:
Entitlement to an earlier effective date for the assignment of total (100%) rating, prior to 8-28-84.
EVIDENCE:
DECISION:
Entitlement to an earlier effective date for tahessignment of total (100%) rating, prior to 8-28-84, is not established.
REASONS AND BASES:
The Board of Veterans Appeals decision dated 9-11-82 affirmed the then assigned 50 percent evaluation for the service connected psychiatric condition. Subsequent to this Decision, based on new and material evidence, the evaluation was increased to 100 percent. The veteran appealed the effective date assigned for the total evaluation, 8-28-84, and the Board of Veterans Appeals Decision of 12-17-85 found this date to be correct. The veteran has repeatedly attempted to have this effective date changed and asked on numerous occasions to have the Board of Veterans Appeals reconsider their Decisions. The Board of Veterans Appeals found their Decisions not clearly in error and denied the veteran's requests for reconsideration.
The veteran now submits evidence attempting to reopen the claim for an earlier effective date,
The evidence submitted since the Board of Veterans Appeals Decision in 1985 is, for the most part duplicate evidence previously considered by the Board of Veterans Appeals. Evidence which is not duplicate, such as VA Review examinations and the multiple volumes concerning "Kangas Report" is not material to the issue of whether an earlier effective date is warranted as the evidence bears in no manner on the assignment of an earlier effective date. The veteran did submit a letter from Dr. Peterson, dated 4-11-88, which referenced his earlier letters in 1981. These 1981 letters were of record when the Board of Veterans Appeals made their Decisions. Dr. Peterson in 1988 stated, in part, that he examined the evaluation report by Dr. Kormos (the report on which the effective date was based) and that the signs and symptoms that Dr. Kormos observed were present during his (Dr. Peterson) treatment in 1980-1981
will be invalidated to prevent unauthorized use, and replacement ecards will
be issued following such invalidation.
Although your fee-basis ID card carries no expiration date, the validity
period for it will expire on October 18, 2003. Approximately 90 days prior to that date, you will be asked to furnish a medical report to justi-
fy your continued need for a fee-basis ID card. Failure to furnish that
medical report might jeopardize continuation of your fee-basis privilege.
Direct inquiries and change of address to this Medical Center. Also, please
notify this Medical Center promptly of any change in the status of your VA
disability rating, such as increases or decreases in percentage of disabili-ty and any disabilities added to or deleted from your rating. This is very important to you as such’ changes may affect this authorization for outpatient
care.
Sincerely,
fo Aude
Enclosures
FL 10-332 (662) 42
January 1984
San Francisco, CA 94105
ss-
Mr. George T. Ojala 2069 "A" Mission Street San Francisco, CA
This is a personal hearing being conducted at the Veterans Administration Regional Office;.San Francisco, before the members of Rating Board Three, Authorization Unit 213,
on September 6, 1984, at 12:60 in the claim of Mr. George P. Ojala, SS=537-44-5070. Let the record show that
the claimant and Roshind Beale are present and have
been duly sworn. The claimant is represented by
Robert Brown of Swords to Plowshares. Mr. Brown, do you
have any statement?
Yes, I would initially just like to give a brief statement of the case, as it were, in just stating that Mr. Ojala or George is a vet who served in the Air Force from August, 1969, to August, 1973.
While in the Republic of Vietnam he received the Distinguished Flying Cross and was honorably discharged. He has seen a lot of combat while in Vietnam as a helicopter mechanic,
and as a result of that service in Vietnam, it has already been established for the record that he has been service
connected at 50 percent for schizo-phrenia. The Board of Veterans Appeals denied his appeal on September 1, 1982, in part granting a temporary total rating based on hospitalization but
denyinn increased rating for schizophrenia. The issue today, as you nave already noted,
is to determine that Gorege is
totally and permanently disabled due to his psychiatric condition, and he is, therefore, socially and industrially
inadaptable. you see before you the psychiatric evaluation of Dr. Foremost, it essentially states that George was
free of any psychotic history. 13
OJALA, George P. ss-
Dr. Rockwood: It would mean coming down from the moun-tains to--
Mr. Ojala: I can't afford it. If you paid for my expenses to come down here--
Dr. Rockwood: No, that we can't guarantee. You
Mr. Ojala: I don't have the money. you're saying. I've had
I hear what tremendous
very angry and bitter, and I'm pretty much over that.
Dr. Rockwood: That one didn't happen here, but we can tell you why. This is a BVA decision. It says that the Paragraph 29 for the two
hospital in "Since the
to apply also to the vet's hospitaliza-tion in 1981," and the second one in 1981, so they granted you those. Now that's when you got the 100 percent
when you were in the hospital. Those are Paragraph 29's. You were getting 50 per— cent when you went into the hospital
at that time and not 100. You got 100 for the time you spent in the hospital,
but the 50 percent was the--When you went into the hospital on 4-1-79, you were rated at 50 percent. You haven't dropped
below 50 percent.
Mr, Ojala: I_was cut. from 100 percent in November er December of 1977 and April of--
a
Your original_one we have here in 1976 which is chronic anxiety with 50 percent. Now I want to check to make sure that
we have the history straight for your
benefit because if you have information 15
OJALA, George P. SS-537-44-5070
that for one reason or other is not correct, it would be our duty to let you know so that you wouldn't carry a misconception around with you. This can happen. We have a
great many veterans who come in to us, and it's not until we get through here
and say, "Hey, we don’t read it that way," and then the veteran realizes that he has the record in front of him
and that maybe he has misjudged or 5 misinterpreted or something. But briefly--Right now the 1976 one is here, and it's
for 50 percent. When you went into ghe hospital at that time, it went to 70 percent in 1977. Why.don't we shut
that off.
Mr. Kershaw: a Let the record show that we were off record to review the veteran's
file quickly and that we accepted the medical report from Dr. Kormos.” At
this time I have just bagically one question of George's representative. Do you
feel that you have presented all the information that you have at this time? Do you have any further statements you’d
like to make?
Mr. Brown: Yes.. Goerge?
I would like to say something. I came in here with some hope that maybe you'd hear me this time. It seems like that's
not going to happen. Now I need to go. and see another VA doctor where I got my benefits cut in the first place. The bottom line for me is that I went to Nam, and there wasn't anything wrong with me.
I don't mean to direct my anger at you.
I don't feel like I'm going to get a fair shake from you. That's how I feel right
now. Your going to get a 45 minute report,
and what can be covered in 45 minutes that four hours of seeing Kormos
is going to do? I know the regulations
16
San Francisco CA 94121
May 10, 2004
In In Repeply ReRefer To: « 662/136B
MR GEORGE P OJALA 111 ORCHARD LN CARLOTTA CA 95528
We are required to possession of a VA Form 10-1iv4)
periodically review the files of those veterans in
Fee Basis Outpatient Medical Care Authorization card (VA
require all veterans who seek care at VA expense to
VA facility.
provided due to geographical inaccessibility.
If the veteran's condition changes, or if VA facilities’ capability is
expanded, constraints of the law require that the authorization for Fee Basis
care be cancelled and that the veteran be requested to report to the VA
facility for needed medical services.
Fee Basis authorization for non-VA care will not be considered a permanent status for any veteran.
After reviewing your file, we find that you meet the criteria for treatment of the medical condition(s) listed on your VA Fee Basis Outpatient Medical Care Authorization card; therefore, your card has been renewed.
period for e it hwill lexpire on uOctober c18, i2006. eApproximatete,90 the yvalidity to
your continued n need e,for othe iFée bBasis ecard. furnish a medical report to justify
Sincerely,
Chomrtwne 4. Aire
Cruz
Fee Services
VA Medical Center Cert # 7003 1680 0002 1438 4395 San Francisco, CA 94121
RE: Preemptive Strike Stealing the R.I.B. (Reduction in Benefits) of Combat Veteran to
Balance the Budget or Bushwhacked, where I’ve Gone Done Did Ei Had Again.
@EEN Lorraine H. Cruz:
ATTENTION: 662/04F Fee Basis Card 0058027
lam writing you at your request. I am enclosing a copy of your letter sent on April 27, 2004 with Five Exhibit’s marked A, B,C,D and E. You have been depriving me of my legally earned Dental Benefit’s since Bush took Office.
You never approved anything for two plus years. I had a root canal done on #30 in 2001 and I hada temporary. You never authorized the Crown and it lay open for over two years. I had the Veterans Center in Eureka make requests, my dentist and my VA Clinic doctor and nothing. When you did get back to me, I had my dentist send a plan to you. You had me see another dentist and then authorized to have two teeth pulled. Number 30 had to be pulled due to infection caused by your non-treatment program. I had a second tooth pulled because of infection. I had a gum infection for over two years and went through ten prescription of antibiotic’s. I have a third tooth.that has been cracked for almost three years now and you havn’t authorized anything.
I hear that you have your own dental implant program run through the VA and why don’t I apply? Why don’t I get follow up treatment for the two holes in my mouth. I know you got a treatment program.
The second issue is the current Fee Basis Card I use to have. I refer to Exhibit B and 662/04F that give me that authorization in November of 2000. You were authorized to send mea 90 day notice (Sept 18, 2003) and you never did. You just cut my Card and misused past documentation to do so. I know that your office didn’t follow the law when you denied the HHFT Bill, enclosed as Exhibit E.
In closing, you owe me a new Fee Basis Card and you need to pay the enclosed Bill. This is my Notice of Disagreement that I am required to file. It is against the law to deny legally earned benefits due to budget cuts. You already have had an injunction filed against you for doing so to other Veterans.
Thank you for prompt action in my case on Both issues.
George Ojala
111 Orchard Lane
19
NaHS a
SAN FRANCISCO CA 94101 C Wr
[] mectcare 2) (Medicaid. x) [—] ‘(Sponsor's ssn) [—] C(VAFleA #) [~] (S8WorloyAN (~)"SN) NG [X] a) ER] ta. INSURE1sa7a ER (FOR PROGRAM IN ITEM 1) 2 PATIENT'S NAME (Last Name, First Name, Middle Initial) 5 PATIENTS GIATY DATE SEX 4 INSURED'S NAHE (LastName, First Name, Middle intial)
OJALA GEORGE P. M1 29 1944 [Xx FC] SAME z Ss
5. PATIENT'S ADDRESS (No, Stet) 6. PATIENT RELATIONSHIP TO INSURED 7. INSURED'S ADDRESS (No., Str | 111 ORCHARD LANE set [ Spouse] chia] other[ |
cry ‘STATE [8 PATIENT STATUS = ea oe 7 STATE. sz
CARLOTTA
ZIOTHER IN95528 ME | stT(787) sE (I768-3226 10Empeee] 'S student] y—_PStudent |] ZIP INSURED'S POLICY GROUP TELCa} (INCLUDE AREACODE) 1S
a. OTHER INSURED'S POLICY OR GROUP NUMBER a EMPLOYMENT? (CURRENT OR PREVIOUS) [a NSURED'S DATE OF BIRTH
pRNo “Ty
b. OTHER INSURED'S DATE OF BIRTH ao ‘SEX ae b. AUTO ACCIDENT? ePLACE (State) [b EMPLOYER'S NAME OR SCHOOL NAME | ao © EMPLOYER'S NAME OR SCHOOL NAME ¢. OTHER ACCIDENT? «INSURANCE PLAN NAME OR PROGRAM NAME ys
<@. INSURANCE PLAN NAME OR PROGRAM NAME Tod. RESERVED FOR LOCAL no @.1S VETERANS HEADMINISSRATIRON =
LJves [no iryes.retSArt and compiete item
12, PATIENT'S hSAUTHORIZED REaON'S SIgovernment | authorize ther releaself orto medical y rwothacinformation nmentsary | 13. INSURED'S cribAUTHORIZED tAundS?@qned physician oauthorize for | |
SIGNED DATE SIGNED
14, DATE OFOCURREN INEGNA(Accident) )R toO) 15. 1F PATIENT HAS EHADMSAME OR SIMILAR ILLNESS. 16. DATES MPATIENT : UNABLE TO WORK IN CUI IRRENT OC Oo CUPYY ON a |
19. RESERVED FOR LOCAL USE
21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY. (RELATE ITEMS 1,2,3 OR 4 TO ITEM 24E BY LINE) ~ 7286 ee ss ¥
18, FROM AR ZATION DA* S RELATED To GUBRENT SERVICES: 1] |
20, OUTSIDE LAB? ‘S$ CHARGES
[ves [no fo
22. MEDICAID RESUBMISSION ORIGINAL REF. NO. 1]
ar ta la cleat aiaais is iat
23. PRIOR AUTHORIZATION NUMBER.
{03232004 |Ose3e004|11/1 | 97110 |
ean oMSODE
F a Shoe
scuances |,UOF S} |Fami| ewe! cos | “tocacuse |
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4 !
|asered04|11}/1
; 7 97110] : a= i 135 0a) 3 A. |__|
AAs57566 |S on
|S
6 25. FEDERAL TAX 1.0. NUMBER ‘= N EIN
31. SIGNATURE OF PHYSICIAN OF SUPPLIER
INCLUDING DEGREES OR CREDENTIALS ppt Tots bil and are ma pat tero0t)
1 | i rE sina |S
26. PATIase ACCOUNT NO. [i (For govt. claims. no e back) 128s TOTAL 37a E aa|s9. AMOUNT ePAID aa| 30. BALANCE QUE a]| | )
AOMBOLST th "HANS"e) Foot THER| AUMBOK D6917 ND IGAND EFOOT ZTHODES i |
(APPROVED BY AMA COUNCIL ON MEDICAL SERVICE 8/82)
CA 95534
PLEASE PRINT OR TYPE
EUREKA CA 9552
GREE 680478244 FORM ONCE ends FORM RFIB:ISOD
21
(1) Veterans Name |(2) ID Number | Period of Validity
GEORGE PAUL OJALA | | FROM: Jul 28, 2004 TO: Oct 28, 2004
(3) AOORESS ~~ *OKTE OF ISSUE | CONDITIONS FOR WHICH SERVICES ARE REQUESTED (DESCRIPTION OF DISABILITY)
| Aug 12, 2004 | I |
JAUTHORIZATION #: 26066-37
APPROVED 12X PHYSICAL THERAPY VISITS. VALIDITY DOS 7-28-04 TO 10- 28-04. PLEASE SEND INCLUSIVE REPORT UPON COMPLETION OF AUTHORIZED COURSE OF TREATMENT. MC 8-12-04.
FOR VA USE ONLY
(5) STATE CODE
6
| (6) COUNTY CODE
|
| 023
| (7) TYPE OF
| PATIENT | 10
| (8) YEAR OF BIRTH
| 1947
| (9) WAR | 0)
| I I o7 |
PURPOSE |
| 1 |
STATION OF JURISDICTION
SAN FRANCISCO VAMC
4150 CLEMENT ST 136B1 SAN FRANCISCO CA 94121
I | (11) CODE
| |
| |
| | SHORT TERM - 1
| | | |
| (12) SEX
| MALE
[orte eecer
| (13) POW
| No |
| APPROVED BY (Name and Title) (NC)
|
TELEPHONE: “415-750-2020 | Lorraine H. Cruz
| Manager, Fee Services A “fe
Information On Veterans Administration Program
Acceptance of this request to render the prescribed services will constitute an agreement which is subject
to the following:
I. SERVICES. If services are not initiated, please return this document to the Station of Jurisdiction with a brief explanation. Unless approved by the VA, services are limited in type and extent to those shown.
II. PERIOD OF VALIDITY. Service must be performed within the period of validity indicated.
If a longer time is needed, please request an extension.
III. REPORTS. Clinical reports are required when an examination only has been requested. Please
submit reports promptly to the Station Of Jurisdiction.
IV. STATEMENT OF ACCOUNTS. Submit a Statement of Account in your usual manner. Your statement must
include: (1) Patient’s Name; (2) Identification NO.; (3) Treatment (CPT) and Dates Rendered: and (4) Fees. V. FEES. Fees claimed may not exceed those made to the general public for like services.
VI. PAYMENT. Payment by the VA for services rendered and approved is payment in full.
VII. HOSPITALIZATION. When a need for hospital care is indicated, please call the Station of Jurisdiction for assistance in admitting the veteran to a VA hospital.
VIII. INQUIRIES. Additional information when required may be obtained by contacting the Station Of Jurisdiction.
SAN FRANCISCO VAMC 4150 CLEMENT ST 136B1
(415) 750-2020
duly 30, 2004 SAN FRANCISCO CALIFORNIA 94121
In Reply Refer To: 662/136B1
OJALA,GEORGE PAUL
PO RBOX 6917 95502-6917 Sf oe | F Sh, 53744-5070) Ww \CVe
5z Fy= e 4} 4 Coe | j REGARDING: VETERAN: GEORGE PAUL OJALA he
VENDOR : HUMBOLDT HAND AND FOOT THER
(Reason for disapproving claim:) Physical therapy at VA
expense must be requested and approved prior to such treatment
request for physical therapy. ecord of receiving and approving a
23
San Francisco CA 94121
MR GEORGE P OJALA 111 ORCHARD LN CARLOTTA CA 95528
Dear Mr. Ojala:
attached provider
for four
authority hoicfurnish ve ooutpatient nt hservices herapy
This authority
covers just
services to
the period indicated
leted in that
at the top-center and requires
ly.
pay according to the established VA fee schedule.
een 8:00 a.m. and 4:00 p.m.
letter, feel free to
5)
Manager, Fee Services
Attachment
25
AVE
95528-9733
NOTICE OF VA PAYMENTS
DEAR G P OJALA,
DURING THE MONTH OF AUGUST 2004, THE VA HEALTH CARE FACILITIES LISTED BELOW PROCESSED THE FOLLOWING PAYMENT(S) ON YOUR BEHALF:
PAYMENT(S) PROCESSED BY VA MEDICAL CENTER SAN FRANCISCO
ITEM PAYEE NAME DATE(S) OF SERVICE AMOUNT
3 HUMBOLDT HAND & FOOT TH
03/16/2004 $79.98 03/23/2004 $86.49
04/01/2004 $86.49
HAS MADE PAYMENTS FOR THESE SAME
YOU ARE AWARE THAT ANY OTHER
SERVICES, PLEASE CONTACT THE
ORGANIZATION
VA FACILITY
SINCERELY,
VA MEDICAL CENTER SAN FRANCISCO
FL 10-481 JULY 1990
460 OCEAN AVENUE FERNDALE, CA 95536 707-786-4151
FAMILY HISTORY LISTING
June 9, 2004 FOR FAMILY OF George Ojala Page 1 HISTORY FOR 01/01/00 TO 06/09/04
Date P/S Patient Proc Desc Prov/Grp Th# Surf Amount Tax Balance
01/31/00 01/31/00 02/28/00 03/02/00
11/28/00 P George 11/28/00 P George 01/28/01 George 02/27/01 George 02/27/01 George
02/28/01 George 03/28/01 George 04/30/01 George 05/29/01 George 06/12/01 P George 06/12/01 P George 07/02/01 George 08/28/01 George 09/26/01 George 10/04/01 P George 10/04/01 P George 10/04/01 P George
11/01/01 P George 11/01/01 P George 01/02/02 George
01/30/02 George 02/26/02 George 03/28/02 George 04/29/02 George 11/12/02 George 05/01/03 George 05/01/03 George 06/03/03 P George 06/03/03 P George 06/03/03 P George 07/07/03 George 12/04/03 U George 12/08/03 P George 01/05/04 P George 01/26/04 George 03/15/04 George 06/09/04 U George
06/09/04 U_ George
Stmt sent 01/31/ / SERVICE CHARGE pDoc/0 Stmt sent 02/28/ /
ADDEC .Adjustment/Decr DOC/0 00210 Film/Intraoral c DOC/0 00120 Evaluation - Per DOC/0
Stmt sent 01/28/ / SERVICE CHARGE poc/0 Stmt sent 02/27/ /
WOFF Write off intere DOC/0 Stmt sent 03/28/ / Stmt sent 04/30/ / Stmt sent 05/29/ fs
00130 Examination - Em DOC/0 3 00220 Film/Intraoral P DOC/0 3 INSUR -Insur 11/28/00 DOoc/0
Stmt sent 08/28/ / Stmt sent 09/26/ /
02750 Crown/porc. to h DOC/0 12 02954 Post & Core, Pre DOC/0 12 00220 Film/Intraoral P DOC/0 12
00120 Evaluation - Per DOC/0 00220 Film/Intraoral P DOC/O 4
INSUR .Insur 10/04/01 Doc/0 Stmt sent 01/30/ t Stmt sent 02/26/ id Stmt sent 03/28/ hs Stmt sent 04/29/ /
INSUR -Insur 11/01/01 pDoc/0 INSUR -Insur 06/12/01 Doc/0 ADDEC .Adjustment/Decr DOC/0 D1110 Prophylaxis - Ad HY¥1/0 DO120 Evaluation - Per DOC/0 DO210 Film/Intraoral C DOC/0 INSUR -Insur 06/03/03 DOC/0 D7140 extraction, erup DOC/0 30 D2920 Crown / Recement DOC/0 29 D7140 extraction, erup DOC/0 19 INSUR -Insur 12/08/03 DOCc/0 INSUR -Insur 01/05/04 DOCc/0 D0120 Evaluation - Per DOC/0 DO210 Film/Intraoral Cc DOC/0
0.00 0.00 0.11 0.00 0.00 0.00
-71.11 0.00 78.00 0.00 29.00 0.00 0.00 0.00 1.60 0.00 0.00 0.00
-1.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 44.00 0.00 36.00 0.00
-107.00 0.00 0.00 0.00 0.00 0.00
700.00 0.00 195.00 0.00 36.00 0.00
29.00 0.00 36.00 0.00
-931.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
-65.00 0.00 0.00 0.00
-80.00 0.00 67.00 0.00 33.00 0.00 82.00 0.00
-182.00 0.00 115.00 0.00 80.00 0.00 115.00 0.00 -80.00 0.00 -115.00 0.00 33.00 0.00
82.00 0.00
71.00 71.11 71.11 0.00 78.00 107.00 107.00 108.60 108.60
107.00 107.00 107.00 107.00 151.00 187.00 80.00
80.00 80.00 780.00 975.00 1,011.00
1,040.00 1,076.00
145.00 145.00 145.00 145.00 145.00 80.00 80.00 0.00 67.00 100.00 182.00 0.00 115.00 195.00 310.00 230.00 115.00 148.00
230.00
APPENDIX
Section 0-12 (Revised)
1. Psychoneuresis Drastic recuctions in evaluations should not be mace in ratings for Beychopeusoais when a reduction to an intermediate
rate ig more in conscnance with the Gecree of Gisability. Moreover,
the general policy to be observec is ¢raduel reéuction in retes to
afford the veteran all possible-eppootdjustment, s
2. Latent Schizophrenia. Severel cases heve been broucht & os attention where regional office rating boards have accordes service connection fer latent schizophrenia. To clear up any misconceptions, 60me explanation is provided.
Generally speakinc, latent schizophrenia is not a proper disability for service connection. While the Diecnostic ané Statistical al
of Hental Disoréers, 1968 Edition, American’ Psychiatric Association, lists the diacnosis in the same section as psychoses, careful readc-ing of the Giagnostic requirements clearly reveals that an essential elerent to the €iscnosis is a history entirely free of psychotic episodes. Following a psychotic reaction, the disebility must be xeclassified for proper Giacnosis, . Therefore, latent schizophrenia
is not a true psychesis. Since it also dces not qualify es a neurosis, there is no besis for service connection for such 2 condition.
Claims for service connection for latent schizophrenia should be
Gisordérs, While the condition is not a disability within the meanin of applicable laws, superimposed psychotic reactions in service or
within the presumptive period wovlé be a proper basis for service
conn ge ee SE,
.—-Post-trauretic Stress Neurosis (Disorder). The type of dis-
ercer contemplated under this diecnestic classification is a psychiatric eisoréer having its onset as an incident of ameé conflict or enemy action, or following bombing, shipwreck, or internment under inhumane
or severely deprived conditions or similar life threatening episoées. To justify the clinical ¢iagnosis and to assure unifo mity of its vse, the following findings should appear in the clinical oxarination presented by the exariney.
100
O-12-1
Section 0-12 (Revised)
Change 282
a. AK recognizable stressor that would be expected to evoke significant s mS in alzost al] inéividvals, that is, a life threatening episoée unéer circwnstances menticned above. It is ‘icportant that this stress be described as to its neture and severity and also in tine sequence, that is, whether it occurred while on active duty,
before service or since discharge therefron.
b. Re-experiencing the traunatic event either by a recurrent and intrusive recollection of the event, dream of the event, or suddenly acting-or feeling as if the traumetic event were occurring because of
an association with an environmental or ideational stimulus.
¢. WNumbing of response to or involvement with the external
world beginning tome time after the trammatic event as shown by markedly diminished interest in one or more significent activities, feeling of Getachment or estrangement from others, or marked constriction of affective responses.
ad. At least two of the following symptoms that were not present prior to the traimetic event:
ABO x (1) Hyperalertness or exaggerated startle response.
(2) Initiel,-middle or terminal sleep disturbance.
(3) Guilt ebout surviving when others have not, or about behavior required to achieve survivel.
(4) Bemory impairment or trouble concentrating.
(5) Avoidance of activities that arouse recollection of the traumatic event.
(6) Intensification of symptoms by exposure to events that sx»abolize or resemble the traunetic event.
jst.Khen,_an_exa(discréer) swhich iGoes tnot hshow athe foregoing findings, c it should be returned as inadequate for rating purposes setting forth the reasons why the cxamination is inadequate.
and chronic. ‘These episodes which ere acute end transitory reactions
101
appellant or representative or unless
the Board determines that
or benefits, to which the evidence re-
lates may be allowed on appeal without
such referral. Such waiver must be in
writing or, if a hearing on
conducted, formally entered on the
record orally at the time of the hear-
(d) Simultaneously contested claims. In
pertinent evidence nwhichd directly at-fects payment, or potential payment, of the benefit sought is submitted by
any claimant and is accepted by the
Board under the provisions of this sec-tion, the substance of such evidence
will be mailed to each of the other
claimants who will then have 60 days
from the date of mailing of notice of
the new evidence within which to com-
ment upon it and/or submit additional evidence in rebuttal. The date of mail-ing of the letter of notification of the new evidence will be presumed to be the same as the date of that letter for
purposes of determining whether such
comment or evidence in rebuttal was timely submitted. No further period will be provided for response to such comment or rebuttal evidence.
25851, May , 15, b. 93, 1992, as amended at 7, 60 9FR,
Subpart O—Revision of Decisions
on Grounds
mistakable Error
otSource: 64 eFR 2139, Jan. 13, 1999, unless
$20.1400 Rule 14
Board decisions.
(a) Review to determine whether istakable error exists in
by fthe Board decision may obe oinitiated
arty to that decision (as the term
4 ” is defined in Rule 1401(b)
is part) in accordance
with Rule 1404 (§ 20.1404 of this part).
(b) All final Board decisions are sub-ject : to revision under this subpart ex-
‘Ty aThose decisions dwhich haveurbeen
competent jurisdiction; and
(2) Decisions on issues pe
subsequently been decided by aco
competent jurisdiction. (Authority: 38 U.S.C. 501(a), 711)
(a) Issue. Unless otherwise Speci
the term “‘issue’’ in this subpart}
a matter upon which the Board a
final decision (other than a a under this subpart). As used in the’
ceding sentence, a “final decision!
was appealable under
of title 38, United States a which would have been so appealab] time of thesdecision. een in effect'ata
(b) Party. As used in this subpart,@ term “party” means any party to'#
proceeding before the Board that
sulted in the final Board decisi which is the subject of a motion und this subpart, but does not include o: cials authorized to file administrati appeals pursuant to §19.51 of this tit (Authority: 38 U.S.C. 501(a), 7104¢a))
20.1402 er Rule ules. 1402. Inapplicability,
Motions filed under this subpart are} not appeals and, except as otherw
Provided, are not subject to the prov
sions of part 19 of this title or this paris
20 which relate to the processing an disposition of appeals.
(Authority: 38 U.S.C. 501(a))
$20.1408 Rule 1403. What constitutes!
and unmistakable error; what
does not.
Contin uel OW’
RECT PAZE af ;
exhibds — FZ ‘
ad
SO
the error. Generally, either the correct
facts, as they were known at the time;
were not before the Board, or the stat-utory and regulatory provisions extant
at the time were incorrectly applied.
(b) Record to be reviewed—{1) General.
Review for clear and unmistakable error in a prior Board decision must be based on the record and the law that existed when that decision was made.
1 BILLED US POSTAL OFFICE FOR PACKET USUALLY SENT THROUGH MAIL