February 6, 2025 • 59 mins
We dissect the VA's approach to rating neurological conditions, revealing how ALS claims are structured to maximize benefits while other similar conditions receive less comprehensive evaluations.
• Bethanie Spangenberg shares concerns about proposed VA changes to neurological rating criteria that could negatively impact veterans
• ALS (Lou Gehrig's Disease) is the only disability presumptively service-connected for all veterans with 90+ days of service
• Veterans are twice as likely as civilians to develop ALS, possibly due to environmental toxins or physical stress during service
• The 12-page ALS DBQ specifically prompts examiners to consider Special Monthly Compensation benefits including aid and attendance
• Unlike ALS, other neurological conditions like Parkinson's disease have DBQs lacking sections for documenting housebound status and SMC needs
• The VA's definition of "loss of use" of extremities has been clarified but remains inconsistently applied across different conditions
• Primary Lateral Sclerosis (PLS), similar to ALS but slower-progressing, faces potential rating reductions under proposed changes
• Veterans with peripheral neuropathy or other neurological conditions should file claims before criteria changes take effect
• Valor for Vet is building resources on diagnostic codes and medical education on their website for veteran reference
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Visit J Basser's Exposed Vet Productions (Formerly Exposed Vet Radioshow) YouTube page by clicking here.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
J Basser (00:03):
Welcome folks to the Exposed Vet Radio Show.
The Exposed Vet Radio Show isbrought to you by Exposed Vet
Productions.
It's now a production showinstead of a radio show, and in
cooperation with Valor for Vet.
My co-host today is Mr Ray Cobb.
I'm looking at him right here.
How are you doing?
Ray Cobb (00:18):
Ray, I'm doing great.
How are you this evening?
J Basser (00:21):
I'm doing really well Before a guy has no teeth and
still talks right.
Hey, great, how are you thisevening?
I'm doing really well beforeguys have no teeth and still
talk right.
But, uh, hey, we got a treat,we've got valor for vets,
bethany spangenberg, and, uh,this is an education.
Only show guys, uh, if you wantto, you know, if you want to
get in a good education of howthe va works and how they do is,
uh, you need to listen to thisshow and others like it.
This show will be posted up onyoutube and some other places,
(00:42):
uh, probably by tomorrow, but Iwant to introduce everybody to
Bethy Spangenberg.
She is the owner of a companycalled Valor for Vet and that's
valorforvetcom, and she is aphysician's assistant and she
does independent medicalopinions for veterans seeking
their disability.
And, without further ado, bethy, how are you?
Bethanie Spangenberg (01:04):
I'm doing great.
I'm excited for this newproduction and see how things go
.
You sound great for not havingany teeth.
J Basser (01:13):
Yeah, well, I went for Christmas and it didn't work
out, I guess.
But I've got temporarysanguinary but I talk better
without them.
I can't whistle At least Idon't whistle as much, right?
But we're going to talk aboutneurology.
We started this on a couple ofshows ago.
Last month we discussed some ofthe neurological issues.
(01:34):
Of course, there's someproposed changes in the mix, and
then the election happened andeverything got turned up on its
head.
So we don't know what's goingto happen now.
But we're going to basically gooff on what we've got and
that's the Title 38, part 4.
And we're going to discuss theDBQ for neurologic conditions
and we're going to focus onthings like ALS today.
Is that right, bethany?
Bethanie Spangenberg (01:53):
That's right, yes, Well, you go ahead
and take off young lady kind ofwhat prompted this particular
show and maybe the next year ofour show, is the VA had proposed
(02:13):
changes to the neurologicconditions and the time frame
for comment was getting ready toclose and I felt that it was
important that we had adiscussion about, you know,
valor for Vet as a company, meas a physician assistant and
accredited agent kind of puttingcomment out there to voice our
(02:34):
concerns with what was beingproposed.
That they were proposingweren't, in my opinion, they
were not going to benefit theveteran, they were going to hurt
the veteran and I felt that itwas important to comment on that
.
And after the show that we had,which is, you know, if they
(02:56):
want to listen to it, we've gotit up on Audible and Spotify and
on our website.
But after that show, I sat downand I wrote a 12-page letter to
the VA outlining the thingsthat I was concerned with.
And in order to continue thediscussion, I wanted to continue
with neurologic conditions andthe VA has like 11 DBQs for
(03:23):
neurologic conditions and I justfelt it appropriate to start at
the top and work our way downthe list.
For ALS or Lou Gehrig's disease, the DBQ itself is 12 pages.
We're not going to go throughevery question and break it down
because it is verycomprehensive, but the key
takeaway for this particularshow is that this DBQ sets the
(03:47):
stage for veterans who havesignificant diseases and that
may need or meet additionalbenefits, such as special
monthly compensation, such ashousebound or aid and attendance
, and that's primarily going tobe the emphasis as we go through
this DBQ.
(04:08):
Now, one thing I do want tomention I'm going to post, you
know, the full response fromlike the 12 page response.
I'm going to post it somewhere.
It's not going to be ideal toread it here.
Nobody wants to.
You guys won't have to wake youup.
But I do want to take a secondand preface today's show with
one of the sections that Italked about in my letter.
(04:31):
All right, sounds good, okay.
So on page 10 of the 12 pages,the section is DBQ structure,
and let me jump to the fronthere because I want I want it to
be clear that the VA isproposing these changes because
(04:52):
they want to.
Their goal is to provide Clearevaluation criteria, improve
rating quality and consistencyand ensure the evaluations are
accurate, and I don't think thattheir theme or purpose was
(05:14):
really clear in their proposedchanges.
And so part of my feedback isthat.
So this section talks about DBQstructure.
Section talks about DBQstructure, ensuring consistency
across neurologic motorconditions such as ALS or Lou
Gehrig's disease.
So word for word, for my finalrecommendation, I would like to
(05:35):
discuss the structure ofdisability benefits
questionnaires.
When comparing DBQs foramyotrophic lateral sclerosis or
ALS, multiple sclerosis,parkinson's disease and other
neurologic motor conditions, itbecomes clear that there are
significant discrepancies intheir design, despite these
conditions often leading tosubstantial dependence as the
(05:56):
disease progresses.
Given that these conditions canresult in the need for aid and
attendance with activities ofdaily living, housebound status
or even bedridden care, it isconcerning that DBQs for
neurologic motor conditions likeParkinson's disease do not
include the same comprehensivesection as those for ALS or
(06:19):
multiple sclerosis.
For example, the ALS DBQincludes specific sections for
documenting housebound status,aid and attendance, higher level
aid and attendance, the use ofassistive devices and the
remaining effective function ofthe extremities.
These sections provideinformation that helps identify
a veteran's need for higherlevels of care and entitlement
(06:42):
to special monthly compensation.
In contrast, the Parkinson'sdisease DBQ lacks these
important sections, creating asignificant gap in assessing the
veteran's true level ofdisability and care needs.
While proposing changes to theDBQ structure may extend beyond
the scope of the current rulechanges.
This discrepancy highlights theneed for broader revisions to
(07:04):
meet the purpose of the proposedrule changes.
This discrepancy highlights theneed for broader revisions to
meet the purpose of the proposedrule changes.
Aligning the structure of DBQsfor neurologic motor conditions,
such as Parkinson's disease,with those for ALS and MS would
provide a more accurate,consistent and clear framework
for evaluating veterans'conditions.
And so again, all over thatproposed rule change, we saw,
(07:27):
you know, them beat the wordsfor accuracy, consistency and
yada, yada, yada.
But I think if that's trulytheir goal, we need to have a
deeper discussion what theseDBQs entail.
So I just wanted to let youguys you know that's part of
what I came up with from ourlast discussion.
(07:47):
So thank you.
I know the whole letter islengthy, so it can be a lot, but
any questions about the letteror that section?
J Basser (07:59):
I don't like to comment about it.
I mean, als is probably theonly disability in the VA system
that anybody who's served andcomes down with ALS I guess I
don't think there's a timeperiod that actually will be
service-connected for it.
That's a disability to whereyou're going to get maximum of
R2 one day and that's the onlygood thing about it, because
(08:20):
when you get your R2, you won'thave it long.
Bethanie Spangenberg (08:23):
Yeah, unfortunately, yeah,
unfortunately.
So when we look at ALS, it'samyotrophic lateral sclerosis.
A lot of people reference it asLou Gehrig's disease.
Lou Gehrig was a baseballplayer in the 1920s, I believe,
(08:43):
and he developed the disease.
And's where it's.
The awareness really spread andso that's how it kind of Lou
Gehrig's disease becomessynonymous with ALS.
But what happens with thatdisease is there are some
dysfunction of the proteins withthe brain and the spinal cord
(09:04):
and it shuts down thecommunication of the nerves from
the brain to the body.
What's sad about ALS is thatthe individual that develops the
disease, they stay cognitivelyintact, meaning they're aware of
the changes.
They're aware that they'relosing feeling in their feet or
losing strength in their feet,they're aware that they're
(09:27):
struggling to swallow orstruggling to breathe, and so
they actually start to suffocatein their own bodies and they're
fully aware of what's happeningbecause the disease as it
progresses, it causesrespiratory failure, it causes
the lungs to stop moving andfunctioning like they're
(09:47):
supposed to.
So that's what's reallyimpactful about ALS is because
it's really emotionally andphysically devastating for the
individual that develops it.
So there is no cure.
There are some medications tokind of delay the progression of
the disease, but typicallythese patients will die between
(10:10):
two and five years afterdiagnosis, so their life
expectancy is pretty short orlimited after diagnosis.
J Basser (10:18):
Unless you're Stephen Hawking.
Bethanie Spangenberg (10:21):
Oh, did he have ALS?
Did he have something?
he had something else well maybeI was gonna say maybe his brain
, he came up with something,because they're actually you
know, what's interesting is,every time we we have a show,
there's something that comes upbeforehand that kind of prefaces
(10:42):
the show without me even tryingto.
So I was reading a book onmitochondrial function and it's
a medical book and it has to dowith how medicine is actually
transitioning to the cellularlevel rather than looking at
just the individual system.
So instead of looking at thecardiovascular system by itself
(11:03):
and just of looking at thecardiovascular system by itself
and just like the endocrinesystem by itself, they're really
starting to look down at thecellular level and realizing
that these systems truly areintegrated and they function
together.
But in that book it was talkingabout ALS and how the problem
is the proteins within the brain.
(11:23):
So we have all these proteinsthat communicate and tell our
body what to do, and part of theproblem with the protein is
that it's folded.
And they have actually shownthat sauna if you go in the
sauna on a regular basis thatthe sauna will help to unfold
that protein that is incorrectlyfolded.
(11:47):
It will unfold it and correctlyfold it back.
So I don't know if StephenHawking tapped into some of that
cellular level brilliance thathe has.
I don't think he advocated forthe sauna, but it sounds like
that we're really trying to looka little bit deeper at some of
these conditions.
So who knows?
J Basser (12:07):
Anyways, I can see the claims filed tomorrow.
Bethanie Spangenberg (12:10):
We need a sauna.
Right, right, it's out there,so that's actually.
Yeah, I'm starting to advocatefor that because I'll get my
husband one.
I can't give you a sauna, how?
About a shoehorn, because I getmy husband, one and all, can't
give you a thought about ashoehorn.
Yeah, hey, let's.
Oh, I'm not going to make anypolitical comments right now.
(12:32):
Two million dollars to whatcountry, for what surgeries, I
don't know.
Anyways, all right, als.
Any questions so far about whatwe talked about?
J Basser (12:49):
That's pretty much it.
I like the studies on the cellsbecause you know you are your
body's nothing but cells.
I think if they can figure thatout, they can maybe cure a lot
of stuff.
They can cure the cells.
Diabetes is one of them.
Cure it, hurry up.
We all three would like that,that's true.
Bethanie Spangenberg (13:11):
Are we all three on insulin pumps?
J Basser (13:14):
No.
Bethanie Spangenberg (13:14):
I don't think so.
Ray Cobb (13:16):
Am I not on here?
Bethanie Spangenberg (13:18):
Not yet.
You're on there.
I'm talking about an insulinpump.
Insulin pump.
J Basser (13:24):
You're still taking a shot, aren't you Ray?
Bethanie Spangenberg (13:29):
You're muted.
J Basser (13:30):
Muted.
Yeah, you're muted, Ray.
He's still taking a shot.
I'm pretty sure of it, becauseI think Pam has to give him to
him because of the situation.
Ray Cobb (13:43):
Can you hear me now.
Yeah, okay, I lost you for awhile there.
J Basser (13:47):
Okay, don't know why You're still taking shots right.
Ray Cobb (13:52):
Yeah, yeah, I still take.
I take four shots a day, okay.
Okay, so and I'm on the U500,which is extremely you know,
extremely powerful.
It's five times stronger than RMm-hmm.
Yes, has some interesting.
(14:15):
For me it's pretty interesting.
Even though I'm on U500, taking65 units, my blood sugar will
go on any given day.
Very seldom comes under 170.
And most of the time staysaround the 200 to 225 level and
(14:39):
they're scared to give me anyhigher dose.
So what do you do?
Bethanie Spangenberg (14:47):
Body's so insulin resistant is what they
tell me you would probablybenefit for a pump, but I don't
know if that's something youwant to tackle With your
situation or levels.
J Basser (15:03):
You'd have to get a high-dose pump, because I don't
think you'd be.
I think you'd go through 150 ina hurry.
Ray Cobb (15:07):
Yeah, I would.
J Basser (15:08):
How are you liking yours so?
Bethanie Spangenberg (15:09):
far John.
J Basser (15:11):
I like it, I love it, I love it to death.
I mean it's, you know itdoesn't let diabetes control
your life, like you know,stopping and pulling the needle
out and doing this and that youknow, sitting in a car waiting
before you go eat, give yourselfa shot, and embarrassment and
things like that.
So it's pretty good for thepsyche and the only thing that
(15:33):
hurts is when that automaticcannula gets inserted.
Yeah, yeah, mm-hmm.
Bethanie Spangenberg (15:51):
So I'm going to kind of go on to the
next section here.
Um for als, als is presumptive.
You have to have 90 days ofactive duty and with that
diagnosis you actually get apriority processing through the
va.
So they they try to get youthrough the system pretty quick
and you jump the line there.
What's also interesting aboutALS and why it's presumptive is
that the medical studies thathave come out, funded by the VA,
(16:13):
has shown that veterans aretwice as likely than the general
population to develop ALS.
So they don't know exactly whypeople develop ALS.
But they're trying to correlatethe difference between the
general population and whatveterans are exposed to.
So they believe there's sometype of toxin in the military
(16:34):
during their time that iscausing these folded proteins to
develop into ALS develop intoALS Specifically I have the
medical article says riskfactors include environmental
exposure such as toxins, andphysical stress associated with
military service.
So that's kind of how that cameabout for it to be presumptive
(16:56):
for all veterans that haveserved 90 days or more Before I
get a little bit right go ahead.
J Basser (17:08):
Yes, go ahead.
I just uh, I just talked, Isaid that to myself oh, okay, um
, I got medical notes here.
Bethanie Spangenberg (17:15):
Typically with als is the individual will
develop symptoms and they reallyhave to go through a workup of
exclusion.
So they're going to have mris,they're going to have nerve,
they're going to have all kindsof testing done before they
finally get down to the ALSdiagnosis.
So from the time of symptomonset until you actually get a
(17:37):
diagnosis could be a few yearsSometimes.
There's another condition thatis very similar to ALS.
It's called PLS and it'sprimary lateral sclerosis.
Um, I believe don't quote me onthat, but I believe it's
primary lateral sclerosis.
The only difference between thetwo is that PLS actually
(17:58):
develops at a slower progression.
Right now the VA rates PLS andALS the same.
In the proposed changes theywere looking at significantly
reducing the PLS compensationand give.
My understanding is that theywere going to give it its own
(18:18):
rating schedule.
In fact, I have it in front ofme they were going to give it
its own rating.
Um, I'm not going to get toofast stuff, but I believe it was
like 10%.
So, and then you would compoundall the other limitations as a
separate disability percentage.
So where ALS gets a hundredpercent, automatically
(18:39):
presumptive, pls is notpresumptive.
It is not.
Uh, they're trying to change itto where it's not 100%.
So again, in the long run thediseases end the same.
Maybe PLS has a little bit oflife extension in comparison to
ALS, but the disease progressionitself is very similar, just
(19:00):
one's quicker than the other.
So I was disappointed to seethat and I know when I looked
through the comments for theproposed changes there was like
10 or 11 plus neurologists orspecialists that commented on
that.
They're like no, this isterrible for these veterans.
You can't you know the, theneed and the, the disease
(19:21):
progression is terrible.
Like you shouldn't be doingthat.
J Basser (19:27):
That guy needs to be unemployed.
Ray Cobb (19:33):
Yeah.
Bethanie Spangenberg (19:37):
ALS can lead to several secondary health
issues, including respiratoryfailure.
That's because what I talkedabout Malnutrition, because they
can't swallow, so they havetroubles with consuming food
towards the end as the diseaseprogresses.
Pneumonia, because with theswallowing they can aspirate and
get some of that food down intotheir lungs and then develop
(19:58):
bacteria.
And then one primary orpredominant secondary condition
is those mental healthconditions that I talked about,
because the person's trapped intheir body.
So it's sad, but those are themedical myths that I have before
we dive into this TVQ, anythingyou guys want to add.
J Basser (20:17):
Diagnostic paralysis.
I know all about that.
So if you lose both of them,you're in trouble.
Bethanie Spangenberg (20:30):
All right, let's jump right into the DBQ.
Like I said before, it's 12pages.
I'm not going to go througheach section, I just want to
kind of lay out the format foreach each section here.
So, as we start off with allDBQs, it's the veteran's
information, the relationshipthe examiner has to the veteran
(20:52):
and the health did I say thatright?
The medical examiner'srelationship to the veteran and
the role that the medicalexaminer plays to that veteran,
such as being their provider ifthey're seen in the clinic.
The next section is evidencereview.
That's standard in all the DBQs.
Often for this one the veteranis going to submit their medical
(21:14):
records and, like I saidpreviously, that workup is going
to be extensive for the medicalexaminer and that has a lot of
value when they go to completethese disability exams.
Section one is the diagnosis.
Section two is the medicalhistory.
Section three question, firstquestion does the veteran report
(21:39):
any muscle weakness in theupper and or lower extremities
attributable to ALS?
Primary symptoms when theyfirst start is going to be
weakness in the upper or lowerextremities.
This is a question that alsoprompts they need to consider
SMC for ALS patients.
(22:01):
The Federal Register does notprompt the Rater to consider SMC
for any other comparableneurologic condition like
(22:22):
Parkinson's disease.
It does not prompt them for SMC, which I find disappointing.
Next question is does theveteran have any pharynx or
larynx or swallowing conditionsattributable to ALS, which we
talked about?
The difficulty swallowing whichcan cause them to develop
pneumonia or malnutrition, thattypically develops later in the
(22:44):
disease.
It's not one of the primarysymptoms that arises.
That's as the diseaseprogresses that the individual
may develop those difficulties.
Question 3C on page three saysdoes the veteran report any
respiratory conditionsattributable to ALS?
The very next question which Ifind interesting is does the
veteran report signs or symptomsof sleep apnea or sleep
(23:09):
apnea-like conditionsattributable to ALS?
That is a secondary conditionthat they're specifically asking
about for ALS.
Why aren't they doing it forthe other conditions?
The next question here talksabout complete or partial loss
of sphincter control as itrelates to stool and the bowels.
(23:31):
That is a special monthlycompensation question.
They're 3F, 3g, question 3I andquestion 3J all prompt special
(23:54):
monthly compensation as itrelates to the bladder and bowel
.
They don't do that for theother ones.
Ray Cobb (24:02):
Any questions so far no, there's a lot of carryover
on those smcs how strong or howlikely, but you may not know.
The answer to this is an end.
Is a veteran given an smc, um,for example, an r1, or even
(24:30):
standard aid and attendancebased on what they're
recommending there or whatthey're referring to there under
their special monthlycompensation?
Does it help the veteran?
Or is it like it is with someof the other, like diabetes,
where they've got to go andprove it and fight for it and it
(24:53):
takes a while to get it?
Bethanie Spangenberg (24:55):
So that's why I feel that it should be
different, because this DBQ islaying it out for the veteran to
get their maximum rating and itdoes not do the same for
diabetes or other medicalconditions.
And I have not had directexperience with ALS specifically
(25:16):
, but I have seen claims for,like former prisoner of war, I
used to be certified in thoseexams they do whatever they can
to get that FPOW at the maxrating percentage that they can.
That is what tone is set forthis ALS DBQ is.
They are trying to captureeverything they possibly can to
(25:38):
support this veteran that hasdeveloped ALS, which I
appreciate.
But why aren't we doing it forthe other conditions?
Why aren't we doing it for ourother?
J Basser (25:46):
veterans.
Actually, this is on the VA,basically on them, because the
court has and we're talking thefederal, not the Veterans Court,
but the one above it has said Iforget the case right now, but
it has said that the VA, it isthe VA's responsibility to
maximize the benefit for theveteran, depending on
(26:06):
circumstances.
Bethanie Spangenberg (26:08):
Yes, that's for every veteran yes,
that's for every veteran.
J Basser (26:15):
Yes, so they're not playing ball with the court, you
know.
They're just doing what theycan do.
Bethanie Spangenberg (26:26):
So if we move along this DBQ here, one I
forgot to mention that also does.
Smc for bladder and bowel is 3L.
I mean we have two and a halfpages just focusing on hey, what
SMC does this veteran qualifyfor?
The other thing that isinteresting with ALS is in the
(26:47):
M21, I believe it's M21, withALS is in the M21, I believe
it's M21, but I know that thereare standard periodic
assessments that the veteran hasfor ALS because of the
progression of the disease.
If they do an exam, the verynext exam is already timed out,
it's already scheduled, becausethey know that that veteran's
disease is going to progress.
(27:08):
So they're doing what they canto capture those benefits in a
timely fashion, which they don'tdo for other.
J Basser (27:19):
You know, when you first started the DBQ, we
started asking about extremitiesand loss of balance and gait
and things like that.
If your first symptoms andfirst signs are loss of use of
your hands and your feet, you'vegot to automatically go to R2.
So any other SMC that they talkabout or give you is a moot
point, because once you get toR2, you're not going no higher,
(27:39):
right, that's true.
Bethanie Spangenberg (27:43):
We're going to jump to page six.
Page six top question is doesthe veteran report erectile
dysfunction or female sexualarousal disorder attributable to
ALS?
So again prompting SMC.
Section four jumps into theneurologic exam.
(28:03):
For these exams they are goingto be pretty comprehensive.
The examiner is going todocument the speech, the
cognition, their gait, how theywalk, strength of the upper and
lower extremities, the reflexesin the upper and lower
extremities.
They're going to want to havethe examiner look at muscle tone
(28:27):
and atrophy and then documentthe severity of the muscle
conditions.
Section five is just an opensection about the other physical
findings that were notpreviously discussed.
Section six says mental healthmanifestations due to ALS or its
(28:51):
treatment.
Does the veteran havedepression, cognitive impairment
or dementia or any other mentaldisorder attributable to ALS?
They are prompting the examinerto trigger a possible secondary
condition that has developed.
They don't do that in the otherDDQs.
Section 7 is specificallydedicated to housebound status
(29:15):
Due to ALS.
Is the veteran substantiallyconfined to his or her dwelling
in the immediate premises or, ifinstitutionalized, to the ward,
or they confined to the ward orthe clinical area.
So they are prompting thebenefit for housebound status.
If we go on to page nine,section eight has questions
(29:40):
dedicated specifically for aidand attendance.
I'm going to read through thesequestions because I think
veterans that are also seekingmay not have ALS but they're
also seeking aid and attendance.
I think they need to be awareof what questions may be asked
or what the expectation is ifyou're seeking that benefit.
So question 8A is the veteranable to dress or undress him or
(30:03):
herself without assistance?
8b does the veteran havesufficient upper extremity
coordination and strength to beable to feed him or herself
without assistance?
8c is the veteran able to attendto the wants of nature, such as
toileting, without assistance?
8d is the veteran able to bathehim or herself without
(30:28):
assistance?
8e is the veteran able to keephim or herself ordinarily clean
and or herself withoutassistance?
A E Is the veteran able to keephim or herself ordinarily clean
and presentable withoutassistance?
A F Does the veteran needfrequent assistance for
adjustment of any specialprosthetic or orthopedic
appliance?
So those questions if you'reever applying for aid and
(30:49):
attendance, those are the typesof questions that you should
expect to hear and have ananswer for so you can express
your need.
Any questions for that.
J Basser (31:07):
I think that would automatically qualify for the
caregiver program too.
Somebody's going to stay athome and work Well yeah, I mean
what you just said.
Ray Cobb (31:14):
It's the answer to those daily activities as it
stands today.
I know that's going to bechanging and going to affect
next October some changes thereas well.
But right now you know one ofthose if you're pre-9-11, is
(31:35):
going to get you aid andattendance level one which is
over $1,500 for your spouse andit goes to her in whatever
account she chooses to go for,chooses to go for.
And if you have three of those,if you're pre-9-11 and only
need two, if you're post-9-11,that's going to put you up to
(31:58):
level two in the caregiver andthat's going to give you an
additional $3,004.
And that is based on, you know,an E4 in your area.
So it could be higher in someareas and lower in others, but
(32:31):
that sounds to me like it'sgoing to be an additional funds
that a spouse will be able toreceive on top of the because of
the ALS and what it does.
J Basser (32:35):
It seems like it would just be automatic for the
caregiver program Should be,because there's no way a spouse
can work and take care of an ALSpatient.
Ray Cobb (32:43):
Well, that's pretty obvious if you're listening to
it.
Yeah, yeah.
J Basser (32:49):
One of my son's teachers.
He died from it or her husbanddied from it.
She had to take off like threeyears or stay with him.
Ray Cobb (32:57):
Well, that was another thing, too, that comes into
play there.
When you have those conditions,you cannot be left alone.
Bethanie Spangenberg (33:15):
The aid and attendance section actually
has two other questions to itthat I didn't read.
It mainly has to do withbedridden uh, the veteran being
bedridden, so ask if they'rebedridden or not.
And they always define this,which I find their definition
interesting says, for VApurposes, being bedridden will
be that the condition whichactually requires that the
claimant remain in bed, the factthat the claimant has
(33:39):
voluntarily taken to bed or thata physician has prescribed rest
in bed for the greater orlesser part of the day to
promote convalescence or curewill not suffice.
The day to promoteconvalescence or cure will not
suffice.
So I don't I don't understandtheir definition of being
required if the physician isprescribing the bed rest.
J Basser (34:01):
It's a condition puts you in the bed and you can't get
out.
Basically, that's whatbedridden status?
Lsd one.
If you can't move yourextremities or your arms and you
can't ambulate or move around,you got to stay in bed.
Ray Cobb (34:15):
There's a couple I've seen with it and actually when
they got them up in a wheelchairthey actually had to take a
sheet or a large towel and tieunder their arms and in the back
of the chair to keep themsitting up or from slumping over
, and that's usually prettyclose to the final days.
Bethanie Spangenb (34:37):
Unfortunately .
I just find it interesting thatthey don't say that like hey,
like if the doctor tells youthat you're required to be in
bed, that doesn't count.
It has to be like you'reinvoluntary bedridden.
Just use the word involuntary.
I don't understand anyways.
Um, this is where the caregiveris prompted in this section.
(35:00):
Does the veteran require careand or assistance on a regular
basis due to his or her physicaland or mental disabilities, in
order to protect him or herselffrom the hazards and or dangers
in his or her daily environment?
So that's when you said theycan't be left alone.
That's where they're promptingthat question.
(35:22):
So the next section, sectionnine, is specifically dedicated
to the need for higher level, amore skilled aid and attendance.
So they're saying that for VApurposes, this skilled, higher
level of care includes, but isnot limited to, healthcare
(35:42):
services such as physicaltherapy, administration of
injections, placement ofindwelling catheters, changing
of sterile dressings and or likefunctions which require
professional health caretraining or the greater
supervision of a trained healthcare professional to perform.
In the absence of this higherlevel of care provided in the
(36:03):
home, the veteran would requirehospitalization, nursing home
care or other residentialinstitutional care.
I don't know of another DBQthat prompts this next step for
aid and attendance.
The higher level Section 10talks about assistive devices.
(36:24):
That's pretty standard in allthe DBQs.
Section 11 is prompting loss ofuse and they have added a better
understanding of what thatmeans to the neurologic changes.
Is they wanted to remove fromthe federal register the
(36:53):
definitions of what the thefunctions were for the muscles,
like where they what they callinnervate, so like internal
rotation of the shoulder,external rotation, like range of
motion.
So the federal register definesthat.
Well, in their proposed changesthey said that the, oh, the
(37:15):
examiners already know whatthose functions are.
We don't need to have themdefined in the Federal Register.
Wait a minute, wait a minute.
We should not be removing anyresources that are there to help
the medical examiner.
Those resources are valuable tothose examiners because they're
not legally trained individuals.
So that actually helps toprovide that consistency that
(37:39):
they say that they're trying toinstill.
So part of the emphasis I'mputting on the need for
education of the medicalexaminer or the need to really
define these things, is thissection right here.
So they in the past have not hadthe definition of what it means
(38:01):
to have no effective functionremaining other than that would
be served as an amputation witha prosthesis remaining, other
than that would be served as anamputation with a prosthesis.
That is a very common questionthat gets asked because they try
to define loss of use saying ifwe would chop the veteran's leg
off and give him a prosthetic,would he have been better off?
(38:22):
And, honestly, when I would dothe DBQs back at the VA, that's
what I would ask.
I would say, okay, so we'relooking at your ankle today.
If I would cut your ankle offand I gave you a fake one, would
you be better off today?
And I would listen to theirresponse and mark you know based
off their response.
(38:42):
And so the understanding ofthat question was not provided
to me in any type of cliniciantraining or any type of handbook
, and so it was a really vaguequestion for an examiner to be
asking, if you don't have anycontext of why that question is
(39:04):
there, what it really means.
So I see that they have addedadditional information regarding
that and I think it's valuablethat I read that out here.
For remaining effective functionof the extremities.
Looking at loss of use.
It says the intention of thissection is to permit the
examiner to quantify the levelof remaining function.
(39:28):
It is not intended to inquirewhether the veteran should
undergo an amputation withfitting of a prosthesis.
For example, if the functionsof grasping with the hand or
propulsion of the feet are aslimited as if the veteran had an
amputation and prosthesis, theexaminer should check, yes, and
(39:49):
describe the diminishingfunction.
The question simply askswhether the functional loss is
to the same degree as if therewere an amputation of the
affected limb.
That definition is not perfect,but it is much better than what
we were previously given Anyquestions regarding that section
(40:17):
no.
Pretty much cut and dry.
So let me read to you what itused to just be, and I want you
to try to wrap your head aroundwhat this means, because even
from a medical standpoint Idon't really understand how they
proposed it so traditionallythis is the only thing that was
(40:40):
in the DBQ.
Due to the ALS condition, isthere functional impairment of
an extremity such that noeffective function remains other
than that which would beequally well served by an
amputation with prosthesis?
So that's why I would ask OK,so if we would cut your ankle
off, give you a fake one, wouldit be better?
(41:01):
So I'm glad they added thatdefinition in there.
Section 12 on page 11 of 12,asks about financial
responsibility.
Basically, in the medicalexaminer's opinion, are they
able to manage their benefitpayments in their best interest,
(41:24):
or at least direct someone elseto do so?
Section 13 talks aboutdiagnostic testing pulmonary
function test, any imaging.
Section 14 talks aboutfunctional impact, which is
pretty standard in all the DBQs.
Section 15 is the remarksstandard in all the DBQs.
(41:46):
Section 16 is the examiner'scertification and their
signature.
So examiner's name, title, areaof practice, their contact
information, their npi, theirmedical license and their state.
So again, that's a lengthy dbq.
I didn't touch each question,um you know word for word, but I
(42:08):
I know that als is adevastating disease and I see
the effort and appreciate theeffort that the va is doing.
However, I feel like we need tomake it consistent for for many
of the conditions that end upcausing the limitations of of
(42:29):
loss, use of loss of bowel andbladder control.
I think there's a lot morethere that we need to address.
J Basser (42:36):
You know the former CMP examiner yourself.
I don't know if you've everdone this.
Have you ever done a CMP for aperson with an injury, a spinal
injury or a paralyzed diaphragm?
You ever done one of?
Bethanie Spangenberg (42:50):
those.
I've had what they callhemiparesis, so it's just one
side versus the other, but noton both.
But I know that the pulmonaryfunction testing is not good.
J Basser (43:02):
No, here's the deal I mean.
What you've got to realize isthat even as an independent
medical examiner yourself, youcan be forceful in this.
Now, if they do an examinationand require a pulmonary function
test that the patient's gotit's already been diagnosed with
a paralyzed diaphragm.
They need to do the test whilethe person's lying down, not
sitting up.
Bethanie Spangenberg (43:23):
I've never heard of that.
What's the difference?
J Basser (43:26):
If you're sitting up, you've got gravity helping you a
little bit and you'll have alittle bit, you know, and you
blow, and you'll have a littlebit of function.
But if you're lying down, thatputs you in an actual condition,
to where you're talking, atleast a 23% drop.
That's what they need to berated on.
Not standing up you should be.
Laying down, make sense.
That makes sense, but they'regoing to do what they want to do
(43:50):
, you know.
So that makes sense, butthey're going to do it there.
They're going to do what theywant to do, you know.
So then they give you a littlejuice at the end when you go in
the box, and that little catchyou with the albuterol because
they can improve your readingbefore they get you out the door
.
Laughter, laughter, laughter.
(44:11):
No, there's certain things andcertain points that you catch on
to over time.
You know, because if you liveit, you know what was done wrong
and you know what needs to bedone right.
Bethanie Spangenberg (44:30):
So I don't know if we've talked about this
before, but at least on arecording anyway.
But I feel like to reallyappreciate where we're at now.
You have to understand how thisprocess has progressed.
So I'm in the process ofwriting the history of
compensation and pension and theprograms that have been built
(44:53):
for our veterans, starting wayfrom the very beginning.
From the very beginning it isinteresting to see you know how
the government has appreciatedthe injuries associated with war
and I think you know thehistory will talk about.
You know the economy at thattime and what the income was
(45:16):
like at that time, what kind ofcompensation was given, what was
considered.
And it was really promptedbecause I came across a legal
advertisement for an attorneygroup out of Cleveland from the
1800s and it outlined how muchveterans would get if they lost
(45:39):
a horse during the war or ifthey had other, you know, an
amputation, like the $6 thatthey would get a month for
having an amputation.
So I think it'll be interestingfor those that enjoy history
and kind of want to understandyou know how we've gotten to,
(45:59):
where we're at and the directionwe're heading, and I'm hoping
to have it's going to be about200, 300 pages, hopefully having
it done in August, so it'll bea good one.
Ray Cobb (46:12):
I'll be interested in that.
Were you aware that back duringthe Civil War, if an attorney
represented you before the VA,the maximum he could charge was
$20 of your back pay?
Bethanie Spangenberg (46:26):
I did not know that.
I haven't you know, it's noteven honestly, it's not even in
that advertisement.
I'll have to go through it.
It's got the old paper stenchand so I have to delicately like
flip those pages.
J Basser (46:38):
Oh yeah yeah, that's a bad stench.
Kind of reminds me of drivingdown through I-40 in Tennessee
in between Knoxville andChattanooga.
They've got a bunch of papermills and the whole damn place
has been right.
Yeah as you go across theOwassee River.
Ray Cobb (47:00):
Oh yeah, oh, my God, whole damn place smells that.
J Basser (47:01):
It right, yeah, you don't actually go across the uh
oasis river yeah exactly whatyou're talking about oh my god,
you gotta roll your windows upand put you put it on the
restart because you do not wantto smell that stuff.
You ever go down 75 goingtoward florida, bethany driving
that way.
When you get there make sureyou got your windows up you know
what's crazy.
Bethanie Spangenberg (47:20):
You say that and I drive to chill coffee
which is 23 minutes up the roadalmost every day and they have
mead paper mill.
It's not mead now, but the thepaper mill has ran chill a
coffee for the last 50 years, soit is on a cloudy day that that
smell is it burns.
J Basser (47:41):
It makes you sick, your stomach.
Ray Cobb (47:43):
Well, you know, right there beside that paper mill,
like you said, on a cloudy dayit's been several years ago now,
probably 25 years ago the worstautomobile collisions took
place right there in that area.
J Basser (47:59):
Foggy day right there in that area, a foggy day and
there was 128 car pileup and Ithink 33 or 34 people lost their
lives.
I heard about that.
I've been stuck in traffic inthat.
I mean we used to go intoGeorgia because Michael was
shooting TV shows and stuff andwe had to go from here to
Georgia several times and I gotstuck in that one.
(48:21):
It was raining and bad wreckand we sat there for about three
hours, isn't that correct?
Ray Cobb (48:25):
Wow, they actually have gates up to shut the
interstate.
Mm-hmm.
J Basser (48:32):
Oh, they got signs, big flashing signs up too, you
know, and it tells you, you knowcertain times.
That's why you need rain.
It's always been bad.
These new vehicles are handy nowbecause they got the front
radar.
That will save your life,because the radar will cut
(48:54):
through that fog but nothingelse will.
You can't see much but theradar.
If the car stops in front ofyou, your car is going to stop
you.
It does stop you.
Get off the road as fast as youcan, because the guy behind you
might be a tractor, trailer andnot have radar.
Bethanie Spangenberg (49:15):
You know, if I transition back to that
whole proposal for neurologicconditions, there was over and I
was impressed with the numberof comments that were submitted.
I was trying to pull it upbefore we got on here.
I can't find it now, but therewas over 50 comments from people
about the proposed changes andall but one all but one opposed
(49:44):
the changes because they did notfeel that it was going to
benefit the veteran.
And the one comment that gavethe proposed changes a complete
stamp of approval was one of thelargest advocacy groups in our
country and I am disappointed.
(50:05):
So I'm not going to say whothey are.
J Basser (50:07):
but You've got to realize.
The guy that probably wrote itwas probably sitting at his
computer at the bar.
He probably had seven rightalready.
I don't know.
Bethanie Spangenberg (50:19):
I'd like to Not the leader.
J Basser (50:47):
I don't know, I'm actually surprised we haven't.
Can I give you some advice asto get there?
Go ahead and look and go ontheir websites and look at these
organizations and start readingtheir bylaws and look where
their true allegiance actuallylies within.
Then your eyes will open andyou'll be enlightened to the new
universe.
Bethanie Spangenberg (51:07):
Our small town supports this major
advocacy group these small towns.
J Basser (51:16):
Have you got that post and the Legion post in the same
town?
Yeah, it's down the street.
Do the sheriffs come by andraid each other because they
keep bootlegging?
It happened a lot in EasternKentucky.
Ray Cobb (51:32):
Oh goodness, it happens a lot in Tennessee too.
I mean, you know Now you saidthe largest group, if I remember
correctly.
Okay, go ahead, okay, go ahead,no, go ahead.
I was going to say, if Iremember correctly the numbers
that I've seen, if you'retalking about largest membership
, the American Legion is thelargest membership and I
(51:57):
disagree with a lot of ourbylaws and I argue with them.
I mean, you know, with thisshow, along with my show, I get
a lot of attention from ourstate commander and my national
commander has come and visitedme personally to be on the show
and I have no problemchallenging them and telling
(52:17):
them how wrong they are.
It is not the American Legion.
Bethanie Spangenberg (52:23):
Oh okay, it's not the largest, but it is
a large.
Ray Cobb (52:28):
Okay, so it's the second largest, so I know who
you're talking about now.
And that goes along with whathe says about the bar.
I can relate with that one too.
Private club yeah, privateorganization.
Private, military organization.
And you know the kind ofinteresting thing when they go
(52:52):
to all three of them, all threeof your majors, when they go to
Congress and talk about how manyvotes they have to get changes
like this made, they don't tellCongress that they hadn't
cleaned up their death row inseven years.
And they're still counting guysthat have been dead for five to
(53:12):
seven years on their roll andthey're not very quick to take
them off.
I've experienced that takingtwo or three years and widows
calling me saying would youplease tell them to quit sending
my husband mail.
He's been dead for two years.
J Basser (53:30):
You know, I bet you still voted.
Ray Cobb (53:39):
Is he from Johnson County down in Texas?
J Basser (53:47):
Johnson County, the famous county, no matter what
state you're in.
Ray Cobb (53:50):
Yeah, Now we'll get a bunch of calls from some of
these guys from Texas now, sinceI made that comment.
J Basser (54:01):
No, yeah, I doubt it.
You might, but don't worry, Igot your back.
We'll send some detective boysdown there.
You used to send a bunch ofboys to Texas, but after the
Alamo they quit doing that.
What's your take on it, beth?
(54:31):
What do you think?
Bethanie Spangenberg (54:32):
uh, I mean if these changes go through,
there's gonna be a lot ofveterans screwed.
Yeah, big time big time ummaybe you know as we.
You know, I don't know the bestway to really kind of
incorporate the letter and someof the things that we discussed
and how I followed up with thosein my request, but I think the
biggest deficit or harm to theveteran is going to come to
(54:54):
these, these, uh, peripheralneuropathies that they're
proposing to change.
Yes, Um we have a DBQ.
I was actually trying to lookup you know the order of the DBQ
, so then that way I could kindof talk about the game plan.
But I know they're coming upprobably towards the end of the
year.
But I think that's actually thebiggest change that's proposed.
(55:18):
That's going to negativelyimpact the veterans is the
peripheral neuropathy.
J Basser (55:22):
My best advice if you're listening or watching the
show, if you've got a claim,even an initial claim, for any
neurological condition eitherit's radiculopathy or whatever
based on a neck injury ordiabetes, diabetic neuropathy I
would strongly recommend you goahead and get this claim in now,
before any change takes effect,because you can be rated on
today's criteria, becausethere's a cutoff date when it
(55:44):
happens.
If it happens, of course, don'tever be reactive, always be
proactive and get it in, becauseyou know if they make changes
like this, it's going to screwthe pooch one of these days.
You know the vascular onesreally got me, yeah, the changes
.
The same guy wrote it.
Bethanie Spangenberg (56:08):
Looking at the neurological conditions
order, the next one is going tobe central nervous system and
neuromuscular diseases, which islike not specifically multiple
sclerosis, but similar.
Maybe we can combine those twoor the next two, but then it's
cranial nerves and then diabeticperipheral neuropathy, then
(56:32):
fibromyalgia.
So we're not.
Peripheral nerves don't comeuntil almost the last one.
So I don't know, maybe we don'thave to go in order.
We can kind of combine and movethings around.
But if you want, john, we canjump to that one next.
That way I can get contentready.
J Basser (56:49):
We can do personal neuropathy next.
That'd be fine.
I have no problem with that,because I think mainly that's
probably going to be yourbiggest hitter when it comes to
the disability, because you knowdiabetes and injuries, I mean,
it's still the same, isn't itfor real nerves.
Bethanie Spangenberg (57:13):
Let's do that then.
J Basser (57:15):
Okay, I have no problem with that.
Well, we've got three minutesleft.
Beth, I think everybody youremail address and how to contact
you if they want to contactValor for Vet and utilize your
all's wonderful services.
Bethanie Spangenberg (57:30):
So our website is wwwvalor4vetcom.
That's Valor V-A-L-O-R.
The number four, vet, v-a-l-o-r.
The number four vet, v-e-t dotcom.
Our phone number is888-448-1011.
We're looking out for a fewthings on our website that is
(57:51):
coming as a change.
We're we're slowly trying toadd all the diagnostic codes,
kind of like similar to militarydisability made easy, but we're
focusing mainly on more of themedical aspect.
Where I'm a physician assistantand patient education when it
comes to diseases is really mypassion, so we're going to be
(58:11):
adding a lot of those articlesand veterans can look the each
blog post up by their diagnosticcode and and learn stuff about,
you know, secondary conditions,prognosis, things like that.
So big things coming in 2025.
I'm looking forward to it.
The book like I mentioned,we're going to be putting out an
interest list where people cansign up if they're interested
(58:34):
and at the book's release we'llsend out an email if they're
interested in in picking up acopy.
Yeah, out an email if they'reinterested in picking up a copy.
Yeah, give us a call.
We have disabled veterans onour team and so they love to
talk just as much as you do, sogive us a call, okay.
J Basser (58:51):
Yes, we do appreciate everybody watching and we'll do
this again next week.
This is John John Stacey.
I am the owner of theExposedNet production group now
I guess we'll call it.
And thanks to Betsy Spangenbergfor coming on and being our
guest and she'll do it againnext month.
She's a monthly guest and wework hand-in-hand with Valid for
(59:11):
Vet.
And I want to thank Mr Ray Cobbdown in Tennessee.
How you doing, ray?
Thank you for coming on, buddyand sitting with us, and with
that we'll be signing off fornow, thank you.
Welcome folks to the Exposed Vet Radio Show.
The Exposed Vet Radio Show isbrought to you by Exposed Vet
Productions.
It's now a production showinstead of a radio show, and in
cooperation with Valor for Vet.
My co-host today is Mr Ray Cobb.
I'm looking at him right here.
How are you doing?
Ray Cobb (00:18):
Ray, I'm doing great.
How are you this evening?
J Basser (00:21):
I'm doing really well Before a guy has no teeth and
still talks right.
Hey, great, how are you thisevening?
I'm doing really well beforeguys have no teeth and still
talk right.
But, uh, hey, we got a treat,we've got valor for vets,
bethany spangenberg, and, uh,this is an education.
Only show guys, uh, if you wantto, you know, if you want to
get in a good education of howthe va works and how they do is,
uh, you need to listen to thisshow and others like it.
This show will be posted up onyoutube and some other places,
(00:42):
uh, probably by tomorrow, but Iwant to introduce everybody to
Bethy Spangenberg.
She is the owner of a companycalled Valor for Vet and that's
valorforvetcom, and she is aphysician's assistant and she
does independent medicalopinions for veterans seeking
their disability.
And, without further ado, bethy, how are you?
Bethanie Spangenberg (01:04):
I'm doing great.
I'm excited for this newproduction and see how things go
.
You sound great for not havingany teeth.
J Basser (01:13):
Yeah, well, I went for Christmas and it didn't work
out, I guess.
But I've got temporarysanguinary but I talk better
without them.
I can't whistle At least Idon't whistle as much, right?
But we're going to talk aboutneurology.
We started this on a couple ofshows ago.
Last month we discussed some ofthe neurological issues.
(01:34):
Of course, there's someproposed changes in the mix, and
then the election happened andeverything got turned up on its
head.
So we don't know what's goingto happen now.
But we're going to basically gooff on what we've got and
that's the Title 38, part 4.
And we're going to discuss theDBQ for neurologic conditions
and we're going to focus onthings like ALS today.
Is that right, bethany?
Bethanie Spangenberg (01:53):
That's right, yes, Well, you go ahead
and take off young lady kind ofwhat prompted this particular
show and maybe the next year ofour show, is the VA had proposed
(02:13):
changes to the neurologicconditions and the time frame
for comment was getting ready toclose and I felt that it was
important that we had adiscussion about, you know,
valor for Vet as a company, meas a physician assistant and
accredited agent kind of puttingcomment out there to voice our
(02:34):
concerns with what was beingproposed.
That they were proposingweren't, in my opinion, they
were not going to benefit theveteran, they were going to hurt
the veteran and I felt that itwas important to comment on that
.
And after the show that we had,which is, you know, if they
(02:56):
want to listen to it, we've gotit up on Audible and Spotify and
on our website.
But after that show, I sat downand I wrote a 12-page letter to
the VA outlining the thingsthat I was concerned with.
And in order to continue thediscussion, I wanted to continue
with neurologic conditions andthe VA has like 11 DBQs for
(03:23):
neurologic conditions and I justfelt it appropriate to start at
the top and work our way downthe list.
For ALS or Lou Gehrig's disease, the DBQ itself is 12 pages.
We're not going to go throughevery question and break it down
because it is verycomprehensive, but the key
takeaway for this particularshow is that this DBQ sets the
(03:47):
stage for veterans who havesignificant diseases and that
may need or meet additionalbenefits, such as special
monthly compensation, such ashousebound or aid and attendance
, and that's primarily going tobe the emphasis as we go through
this DBQ.
(04:08):
Now, one thing I do want tomention I'm going to post, you
know, the full response fromlike the 12 page response.
I'm going to post it somewhere.
It's not going to be ideal toread it here.
Nobody wants to.
You guys won't have to wake youup.
But I do want to take a secondand preface today's show with
one of the sections that Italked about in my letter.
(04:31):
All right, sounds good, okay.
So on page 10 of the 12 pages,the section is DBQ structure,
and let me jump to the fronthere because I want I want it to
be clear that the VA isproposing these changes because
(04:52):
they want to.
Their goal is to provide Clearevaluation criteria, improve
rating quality and consistencyand ensure the evaluations are
accurate, and I don't think thattheir theme or purpose was
(05:14):
really clear in their proposedchanges.
And so part of my feedback isthat.
So this section talks about DBQstructure.
Section talks about DBQstructure, ensuring consistency
across neurologic motorconditions such as ALS or Lou
Gehrig's disease.
So word for word, for my finalrecommendation, I would like to
(05:35):
discuss the structure ofdisability benefits
questionnaires.
When comparing DBQs foramyotrophic lateral sclerosis or
ALS, multiple sclerosis,parkinson's disease and other
neurologic motor conditions, itbecomes clear that there are
significant discrepancies intheir design, despite these
conditions often leading tosubstantial dependence as the
(05:56):
disease progresses.
Given that these conditions canresult in the need for aid and
attendance with activities ofdaily living, housebound status
or even bedridden care, it isconcerning that DBQs for
neurologic motor conditions likeParkinson's disease do not
include the same comprehensivesection as those for ALS or
(06:19):
multiple sclerosis.
For example, the ALS DBQincludes specific sections for
documenting housebound status,aid and attendance, higher level
aid and attendance, the use ofassistive devices and the
remaining effective function ofthe extremities.
These sections provideinformation that helps identify
a veteran's need for higherlevels of care and entitlement
(06:42):
to special monthly compensation.
In contrast, the Parkinson'sdisease DBQ lacks these
important sections, creating asignificant gap in assessing the
veteran's true level ofdisability and care needs.
While proposing changes to theDBQ structure may extend beyond
the scope of the current rulechanges.
This discrepancy highlights theneed for broader revisions to
(07:04):
meet the purpose of the proposedrule changes.
This discrepancy highlights theneed for broader revisions to
meet the purpose of the proposedrule changes.
Aligning the structure of DBQsfor neurologic motor conditions,
such as Parkinson's disease,with those for ALS and MS would
provide a more accurate,consistent and clear framework
for evaluating veterans'conditions.
And so again, all over thatproposed rule change, we saw,
(07:27):
you know, them beat the wordsfor accuracy, consistency and
yada, yada, yada.
But I think if that's trulytheir goal, we need to have a
deeper discussion what theseDBQs entail.
So I just wanted to let youguys you know that's part of
what I came up with from ourlast discussion.
(07:47):
So thank you.
I know the whole letter islengthy, so it can be a lot, but
any questions about the letteror that section?
J Basser (07:59):
I don't like to comment about it.
I mean, als is probably theonly disability in the VA system
that anybody who's served andcomes down with ALS I guess I
don't think there's a timeperiod that actually will be
service-connected for it.
That's a disability to whereyou're going to get maximum of
R2 one day and that's the onlygood thing about it, because
(08:20):
when you get your R2, you won'thave it long.
Bethanie Spangenberg (08:23):
Yeah, unfortunately, yeah,
unfortunately.
So when we look at ALS, it'samyotrophic lateral sclerosis.
A lot of people reference it asLou Gehrig's disease.
Lou Gehrig was a baseballplayer in the 1920s, I believe,
(08:43):
and he developed the disease.
And's where it's.
The awareness really spread andso that's how it kind of Lou
Gehrig's disease becomessynonymous with ALS.
But what happens with thatdisease is there are some
dysfunction of the proteins withthe brain and the spinal cord
(09:04):
and it shuts down thecommunication of the nerves from
the brain to the body.
What's sad about ALS is thatthe individual that develops the
disease, they stay cognitivelyintact, meaning they're aware of
the changes.
They're aware that they'relosing feeling in their feet or
losing strength in their feet,they're aware that they're
(09:27):
struggling to swallow orstruggling to breathe, and so
they actually start to suffocatein their own bodies and they're
fully aware of what's happeningbecause the disease as it
progresses, it causesrespiratory failure, it causes
the lungs to stop moving andfunctioning like they're
(09:47):
supposed to.
So that's what's reallyimpactful about ALS is because
it's really emotionally andphysically devastating for the
individual that develops it.
So there is no cure.
There are some medications tokind of delay the progression of
the disease, but typicallythese patients will die between
(10:10):
two and five years afterdiagnosis, so their life
expectancy is pretty short orlimited after diagnosis.
J Basser (10:18):
Unless you're Stephen Hawking.
Bethanie Spangenberg (10:21):
Oh, did he have ALS?
Did he have something?
he had something else well maybeI was gonna say maybe his brain
, he came up with something,because they're actually you
know, what's interesting is,every time we we have a show,
there's something that comes upbeforehand that kind of prefaces
(10:42):
the show without me even tryingto.
So I was reading a book onmitochondrial function and it's
a medical book and it has to dowith how medicine is actually
transitioning to the cellularlevel rather than looking at
just the individual system.
So instead of looking at thecardiovascular system by itself
(11:03):
and just of looking at thecardiovascular system by itself
and just like the endocrinesystem by itself, they're really
starting to look down at thecellular level and realizing
that these systems truly areintegrated and they function
together.
But in that book it was talkingabout ALS and how the problem
is the proteins within the brain.
(11:23):
So we have all these proteinsthat communicate and tell our
body what to do, and part of theproblem with the protein is
that it's folded.
And they have actually shownthat sauna if you go in the
sauna on a regular basis thatthe sauna will help to unfold
that protein that is incorrectlyfolded.
(11:47):
It will unfold it and correctlyfold it back.
So I don't know if StephenHawking tapped into some of that
cellular level brilliance thathe has.
I don't think he advocated forthe sauna, but it sounds like
that we're really trying to looka little bit deeper at some of
these conditions.
So who knows?
J Basser (12:07):
Anyways, I can see the claims filed tomorrow.
Bethanie Spangenberg (12:10):
We need a sauna.
Right, right, it's out there,so that's actually.
Yeah, I'm starting to advocatefor that because I'll get my
husband one.
I can't give you a sauna, how?
About a shoehorn, because I getmy husband, one and all, can't
give you a thought about ashoehorn.
Yeah, hey, let's.
Oh, I'm not going to make anypolitical comments right now.
(12:32):
Two million dollars to whatcountry, for what surgeries, I
don't know.
Anyways, all right, als.
Any questions so far about whatwe talked about?
J Basser (12:49):
That's pretty much it.
I like the studies on the cellsbecause you know you are your
body's nothing but cells.
I think if they can figure thatout, they can maybe cure a lot
of stuff.
They can cure the cells.
Diabetes is one of them.
Cure it, hurry up.
We all three would like that,that's true.
Bethanie Spangenberg (13:11):
Are we all three on insulin pumps?
J Basser (13:14):
No.
Bethanie Spangenberg (13:14):
I don't think so.
Ray Cobb (13:16):
Am I not on here?
Bethanie Spangenberg (13:18):
Not yet.
You're on there.
I'm talking about an insulinpump.
Insulin pump.
J Basser (13:24):
You're still taking a shot, aren't you Ray?
Bethanie Spangenberg (13:29):
You're muted.
J Basser (13:30):
Muted.
Yeah, you're muted, Ray.
He's still taking a shot.
I'm pretty sure of it, becauseI think Pam has to give him to
him because of the situation.
Ray Cobb (13:43):
Can you hear me now.
Yeah, okay, I lost you for awhile there.
J Basser (13:47):
Okay, don't know why You're still taking shots right.
Ray Cobb (13:52):
Yeah, yeah, I still take.
I take four shots a day, okay.
Okay, so and I'm on the U500,which is extremely you know,
extremely powerful.
It's five times stronger than RMm-hmm.
Yes, has some interesting.
(14:15):
For me it's pretty interesting.
Even though I'm on U500, taking65 units, my blood sugar will
go on any given day.
Very seldom comes under 170.
And most of the time staysaround the 200 to 225 level and
(14:39):
they're scared to give me anyhigher dose.
So what do you do?
Bethanie Spangenberg (14:47):
Body's so insulin resistant is what they
tell me you would probablybenefit for a pump, but I don't
know if that's something youwant to tackle With your
situation or levels.
J Basser (15:03):
You'd have to get a high-dose pump, because I don't
think you'd be.
I think you'd go through 150 ina hurry.
Ray Cobb (15:07):
Yeah, I would.
J Basser (15:08):
How are you liking yours so?
Bethanie Spangenberg (15:09):
far John.
J Basser (15:11):
I like it, I love it, I love it to death.
I mean it's, you know itdoesn't let diabetes control
your life, like you know,stopping and pulling the needle
out and doing this and that youknow, sitting in a car waiting
before you go eat, give yourselfa shot, and embarrassment and
things like that.
So it's pretty good for thepsyche and the only thing that
(15:33):
hurts is when that automaticcannula gets inserted.
Yeah, yeah, mm-hmm.
Bethanie Spangenberg (15:51):
So I'm going to kind of go on to the
next section here.
Um for als, als is presumptive.
You have to have 90 days ofactive duty and with that
diagnosis you actually get apriority processing through the
va.
So they they try to get youthrough the system pretty quick
and you jump the line there.
What's also interesting aboutALS and why it's presumptive is
that the medical studies thathave come out, funded by the VA,
(16:13):
has shown that veterans aretwice as likely than the general
population to develop ALS.
So they don't know exactly whypeople develop ALS.
But they're trying to correlatethe difference between the
general population and whatveterans are exposed to.
So they believe there's sometype of toxin in the military
(16:34):
during their time that iscausing these folded proteins to
develop into ALS develop intoALS Specifically I have the
medical article says riskfactors include environmental
exposure such as toxins, andphysical stress associated with
military service.
So that's kind of how that cameabout for it to be presumptive
(16:56):
for all veterans that haveserved 90 days or more Before I
get a little bit right go ahead.
J Basser (17:08):
Yes, go ahead.
I just uh, I just talked, Isaid that to myself oh, okay, um
, I got medical notes here.
Bethanie Spangenberg (17:15):
Typically with als is the individual will
develop symptoms and they reallyhave to go through a workup of
exclusion.
So they're going to have mris,they're going to have nerve,
they're going to have all kindsof testing done before they
finally get down to the ALSdiagnosis.
So from the time of symptomonset until you actually get a
(17:37):
diagnosis could be a few yearsSometimes.
There's another condition thatis very similar to ALS.
It's called PLS and it'sprimary lateral sclerosis.
Um, I believe don't quote me onthat, but I believe it's
primary lateral sclerosis.
The only difference between thetwo is that PLS actually
(17:58):
develops at a slower progression.
Right now the VA rates PLS andALS the same.
In the proposed changes theywere looking at significantly
reducing the PLS compensationand give.
My understanding is that theywere going to give it its own
(18:18):
rating schedule.
In fact, I have it in front ofme they were going to give it
its own rating.
Um, I'm not going to get toofast stuff, but I believe it was
like 10%.
So, and then you would compoundall the other limitations as a
separate disability percentage.
So where ALS gets a hundredpercent, automatically
(18:39):
presumptive, pls is notpresumptive.
It is not.
Uh, they're trying to change itto where it's not 100%.
So again, in the long run thediseases end the same.
Maybe PLS has a little bit oflife extension in comparison to
ALS, but the disease progressionitself is very similar, just
(19:00):
one's quicker than the other.
So I was disappointed to seethat and I know when I looked
through the comments for theproposed changes there was like
10 or 11 plus neurologists orspecialists that commented on
that.
They're like no, this isterrible for these veterans.
You can't you know the, theneed and the, the disease
(19:21):
progression is terrible.
Like you shouldn't be doingthat.
J Basser (19:27):
That guy needs to be unemployed.
Ray Cobb (19:33):
Yeah.
Bethanie Spangenberg (19:37):
ALS can lead to several secondary health
issues, including respiratoryfailure.
That's because what I talkedabout Malnutrition, because they
can't swallow, so they havetroubles with consuming food
towards the end as the diseaseprogresses.
Pneumonia, because with theswallowing they can aspirate and
get some of that food down intotheir lungs and then develop
(19:58):
bacteria.
And then one primary orpredominant secondary condition
is those mental healthconditions that I talked about,
because the person's trapped intheir body.
So it's sad, but those are themedical myths that I have before
we dive into this TVQ, anythingyou guys want to add.
J Basser (20:17):
Diagnostic paralysis.
I know all about that.
So if you lose both of them,you're in trouble.
Bethanie Spangenberg (20:30):
All right, let's jump right into the DBQ.
Like I said before, it's 12pages.
I'm not going to go througheach section, I just want to
kind of lay out the format foreach each section here.
So, as we start off with allDBQs, it's the veteran's
information, the relationshipthe examiner has to the veteran
(20:52):
and the health did I say thatright?
The medical examiner'srelationship to the veteran and
the role that the medicalexaminer plays to that veteran,
such as being their provider ifthey're seen in the clinic.
The next section is evidencereview.
That's standard in all the DBQs.
Often for this one the veteranis going to submit their medical
(21:14):
records and, like I saidpreviously, that workup is going
to be extensive for the medicalexaminer and that has a lot of
value when they go to completethese disability exams.
Section one is the diagnosis.
Section two is the medicalhistory.
Section three question, firstquestion does the veteran report
(21:39):
any muscle weakness in theupper and or lower extremities
attributable to ALS?
Primary symptoms when theyfirst start is going to be
weakness in the upper or lowerextremities.
This is a question that alsoprompts they need to consider
SMC for ALS patients.
(22:01):
The Federal Register does notprompt the Rater to consider SMC
for any other comparableneurologic condition like
(22:22):
Parkinson's disease.
It does not prompt them for SMC, which I find disappointing.
Next question is does theveteran have any pharynx or
larynx or swallowing conditionsattributable to ALS, which we
talked about?
The difficulty swallowing whichcan cause them to develop
pneumonia or malnutrition, thattypically develops later in the
(22:44):
disease.
It's not one of the primarysymptoms that arises.
That's as the diseaseprogresses that the individual
may develop those difficulties.
Question 3C on page three saysdoes the veteran report any
respiratory conditionsattributable to ALS?
The very next question which Ifind interesting is does the
veteran report signs or symptomsof sleep apnea or sleep
(23:09):
apnea-like conditionsattributable to ALS?
That is a secondary conditionthat they're specifically asking
about for ALS.
Why aren't they doing it forthe other conditions?
The next question here talksabout complete or partial loss
of sphincter control as itrelates to stool and the bowels.
(23:31):
That is a special monthlycompensation question.
They're 3F, 3g, question 3I andquestion 3J all prompt special
(23:54):
monthly compensation as itrelates to the bladder and bowel
.
They don't do that for theother ones.
Ray Cobb (24:02):
Any questions so far no, there's a lot of carryover
on those smcs how strong or howlikely, but you may not know.
The answer to this is an end.
Is a veteran given an smc, um,for example, an r1, or even
(24:30):
standard aid and attendancebased on what they're
recommending there or whatthey're referring to there under
their special monthlycompensation?
Does it help the veteran?
Or is it like it is with someof the other, like diabetes,
where they've got to go andprove it and fight for it and it
(24:53):
takes a while to get it?
Bethanie Spangenberg (24:55):
So that's why I feel that it should be
different, because this DBQ islaying it out for the veteran to
get their maximum rating and itdoes not do the same for
diabetes or other medicalconditions.
And I have not had directexperience with ALS specifically
(25:16):
, but I have seen claims for,like former prisoner of war, I
used to be certified in thoseexams they do whatever they can
to get that FPOW at the maxrating percentage that they can.
That is what tone is set forthis ALS DBQ is.
They are trying to captureeverything they possibly can to
(25:38):
support this veteran that hasdeveloped ALS, which I
appreciate.
But why aren't we doing it forthe other conditions?
Why aren't we doing it for ourother?
J Basser (25:46):
veterans.
Actually, this is on the VA,basically on them, because the
court has and we're talking thefederal, not the Veterans Court,
but the one above it has said Iforget the case right now, but
it has said that the VA, it isthe VA's responsibility to
maximize the benefit for theveteran, depending on
(26:06):
circumstances.
Bethanie Spangenberg (26:08):
Yes, that's for every veteran yes,
that's for every veteran.
J Basser (26:15):
Yes, so they're not playing ball with the court, you
know.
They're just doing what theycan do.
Bethanie Spangenberg (26:26):
So if we move along this DBQ here, one I
forgot to mention that also does.
Smc for bladder and bowel is 3L.
I mean we have two and a halfpages just focusing on hey, what
SMC does this veteran qualifyfor?
The other thing that isinteresting with ALS is in the
(26:47):
M21, I believe it's M21, withALS is in the M21, I believe
it's M21, but I know that thereare standard periodic
assessments that the veteran hasfor ALS because of the
progression of the disease.
If they do an exam, the verynext exam is already timed out,
it's already scheduled, becausethey know that that veteran's
disease is going to progress.
(27:08):
So they're doing what they canto capture those benefits in a
timely fashion, which they don'tdo for other.
J Basser (27:19):
You know, when you first started the DBQ, we
started asking about extremitiesand loss of balance and gait
and things like that.
If your first symptoms andfirst signs are loss of use of
your hands and your feet, you'vegot to automatically go to R2.
So any other SMC that they talkabout or give you is a moot
point, because once you get toR2, you're not going no higher,
(27:39):
right, that's true.
Bethanie Spangenberg (27:43):
We're going to jump to page six.
Page six top question is doesthe veteran report erectile
dysfunction or female sexualarousal disorder attributable to
ALS?
So again prompting SMC.
Section four jumps into theneurologic exam.
(28:03):
For these exams they are goingto be pretty comprehensive.
The examiner is going todocument the speech, the
cognition, their gait, how theywalk, strength of the upper and
lower extremities, the reflexesin the upper and lower
extremities.
They're going to want to havethe examiner look at muscle tone
(28:27):
and atrophy and then documentthe severity of the muscle
conditions.
Section five is just an opensection about the other physical
findings that were notpreviously discussed.
Section six says mental healthmanifestations due to ALS or its
(28:51):
treatment.
Does the veteran havedepression, cognitive impairment
or dementia or any other mentaldisorder attributable to ALS?
They are prompting the examinerto trigger a possible secondary
condition that has developed.
They don't do that in the otherDDQs.
Section 7 is specificallydedicated to housebound status
(29:15):
Due to ALS.
Is the veteran substantiallyconfined to his or her dwelling
in the immediate premises or, ifinstitutionalized, to the ward,
or they confined to the ward orthe clinical area.
So they are prompting thebenefit for housebound status.
If we go on to page nine,section eight has questions
(29:40):
dedicated specifically for aidand attendance.
I'm going to read through thesequestions because I think
veterans that are also seekingmay not have ALS but they're
also seeking aid and attendance.
I think they need to be awareof what questions may be asked
or what the expectation is ifyou're seeking that benefit.
So question 8A is the veteranable to dress or undress him or
(30:03):
herself without assistance?
8b does the veteran havesufficient upper extremity
coordination and strength to beable to feed him or herself
without assistance?
8c is the veteran able to attendto the wants of nature, such as
toileting, without assistance?
8d is the veteran able to bathehim or herself without
(30:28):
assistance?
8e is the veteran able to keephim or herself ordinarily clean
and or herself withoutassistance?
A E Is the veteran able to keephim or herself ordinarily clean
and presentable withoutassistance?
A F Does the veteran needfrequent assistance for
adjustment of any specialprosthetic or orthopedic
appliance?
So those questions if you'reever applying for aid and
(30:49):
attendance, those are the typesof questions that you should
expect to hear and have ananswer for so you can express
your need.
Any questions for that.
J Basser (31:07):
I think that would automatically qualify for the
caregiver program too.
Somebody's going to stay athome and work Well yeah, I mean
what you just said.
Ray Cobb (31:14):
It's the answer to those daily activities as it
stands today.
I know that's going to bechanging and going to affect
next October some changes thereas well.
But right now you know one ofthose if you're pre-9-11, is
(31:35):
going to get you aid andattendance level one which is
over $1,500 for your spouse andit goes to her in whatever
account she chooses to go for,chooses to go for.
And if you have three of those,if you're pre-9-11 and only
need two, if you're post-9-11,that's going to put you up to
(31:58):
level two in the caregiver andthat's going to give you an
additional $3,004.
And that is based on, you know,an E4 in your area.
So it could be higher in someareas and lower in others, but
(32:31):
that sounds to me like it'sgoing to be an additional funds
that a spouse will be able toreceive on top of the because of
the ALS and what it does.
J Basser (32:35):
It seems like it would just be automatic for the
caregiver program Should be,because there's no way a spouse
can work and take care of an ALSpatient.
Ray Cobb (32:43):
Well, that's pretty obvious if you're listening to
it.
Yeah, yeah.
J Basser (32:49):
One of my son's teachers.
He died from it or her husbanddied from it.
She had to take off like threeyears or stay with him.
Ray Cobb (32:57):
Well, that was another thing, too, that comes into
play there.
When you have those conditions,you cannot be left alone.
Bethanie Spangenberg (33:15):
The aid and attendance section actually
has two other questions to itthat I didn't read.
It mainly has to do withbedridden uh, the veteran being
bedridden, so ask if they'rebedridden or not.
And they always define this,which I find their definition
interesting says, for VApurposes, being bedridden will
be that the condition whichactually requires that the
claimant remain in bed, the factthat the claimant has
(33:39):
voluntarily taken to bed or thata physician has prescribed rest
in bed for the greater orlesser part of the day to
promote convalescence or curewill not suffice.
The day to promoteconvalescence or cure will not
suffice.
So I don't I don't understandtheir definition of being
required if the physician isprescribing the bed rest.
J Basser (34:01):
It's a condition puts you in the bed and you can't get
out.
Basically, that's whatbedridden status?
Lsd one.
If you can't move yourextremities or your arms and you
can't ambulate or move around,you got to stay in bed.
Ray Cobb (34:15):
There's a couple I've seen with it and actually when
they got them up in a wheelchairthey actually had to take a
sheet or a large towel and tieunder their arms and in the back
of the chair to keep themsitting up or from slumping over
, and that's usually prettyclose to the final days.
Bethanie Spangenb (34:37):
Unfortunately .
I just find it interesting thatthey don't say that like hey,
like if the doctor tells youthat you're required to be in
bed, that doesn't count.
It has to be like you'reinvoluntary bedridden.
Just use the word involuntary.
I don't understand anyways.
Um, this is where the caregiveris prompted in this section.
(35:00):
Does the veteran require careand or assistance on a regular
basis due to his or her physicaland or mental disabilities, in
order to protect him or herselffrom the hazards and or dangers
in his or her daily environment?
So that's when you said theycan't be left alone.
That's where they're promptingthat question.
(35:22):
So the next section, sectionnine, is specifically dedicated
to the need for higher level, amore skilled aid and attendance.
So they're saying that for VApurposes, this skilled, higher
level of care includes, but isnot limited to, healthcare
(35:42):
services such as physicaltherapy, administration of
injections, placement ofindwelling catheters, changing
of sterile dressings and or likefunctions which require
professional health caretraining or the greater
supervision of a trained healthcare professional to perform.
In the absence of this higherlevel of care provided in the
(36:03):
home, the veteran would requirehospitalization, nursing home
care or other residentialinstitutional care.
I don't know of another DBQthat prompts this next step for
aid and attendance.
The higher level Section 10talks about assistive devices.
(36:24):
That's pretty standard in allthe DBQs.
Section 11 is prompting loss ofuse and they have added a better
understanding of what thatmeans to the neurologic changes.
Is they wanted to remove fromthe federal register the
(36:53):
definitions of what the thefunctions were for the muscles,
like where they what they callinnervate, so like internal
rotation of the shoulder,external rotation, like range of
motion.
So the federal register definesthat.
Well, in their proposed changesthey said that the, oh, the
(37:15):
examiners already know whatthose functions are.
We don't need to have themdefined in the Federal Register.
Wait a minute, wait a minute.
We should not be removing anyresources that are there to help
the medical examiner.
Those resources are valuable tothose examiners because they're
not legally trained individuals.
So that actually helps toprovide that consistency that
(37:39):
they say that they're trying toinstill.
So part of the emphasis I'mputting on the need for
education of the medicalexaminer or the need to really
define these things, is thissection right here.
So they in the past have not hadthe definition of what it means
(38:01):
to have no effective functionremaining other than that would
be served as an amputation witha prosthesis remaining, other
than that would be served as anamputation with a prosthesis.
That is a very common questionthat gets asked because they try
to define loss of use saying ifwe would chop the veteran's leg
off and give him a prosthetic,would he have been better off?
(38:22):
And, honestly, when I would dothe DBQs back at the VA, that's
what I would ask.
I would say, okay, so we'relooking at your ankle today.
If I would cut your ankle offand I gave you a fake one, would
you be better off today?
And I would listen to theirresponse and mark you know based
off their response.
(38:42):
And so the understanding ofthat question was not provided
to me in any type of cliniciantraining or any type of handbook
, and so it was a really vaguequestion for an examiner to be
asking, if you don't have anycontext of why that question is
(39:04):
there, what it really means.
So I see that they have addedadditional information regarding
that and I think it's valuablethat I read that out here.
For remaining effective functionof the extremities.
Looking at loss of use.
It says the intention of thissection is to permit the
examiner to quantify the levelof remaining function.
(39:28):
It is not intended to inquirewhether the veteran should
undergo an amputation withfitting of a prosthesis.
For example, if the functionsof grasping with the hand or
propulsion of the feet are aslimited as if the veteran had an
amputation and prosthesis, theexaminer should check, yes, and
(39:49):
describe the diminishingfunction.
The question simply askswhether the functional loss is
to the same degree as if therewere an amputation of the
affected limb.
That definition is not perfect,but it is much better than what
we were previously given Anyquestions regarding that section
(40:17):
no.
Pretty much cut and dry.
So let me read to you what itused to just be, and I want you
to try to wrap your head aroundwhat this means, because even
from a medical standpoint Idon't really understand how they
proposed it so traditionallythis is the only thing that was
(40:40):
in the DBQ.
Due to the ALS condition, isthere functional impairment of
an extremity such that noeffective function remains other
than that which would beequally well served by an
amputation with prosthesis?
So that's why I would ask OK,so if we would cut your ankle
off, give you a fake one, wouldit be better?
(41:01):
So I'm glad they added thatdefinition in there.
Section 12 on page 11 of 12,asks about financial
responsibility.
Basically, in the medicalexaminer's opinion, are they
able to manage their benefitpayments in their best interest,
(41:24):
or at least direct someone elseto do so?
Section 13 talks aboutdiagnostic testing pulmonary
function test, any imaging.
Section 14 talks aboutfunctional impact, which is
pretty standard in all the DBQs.
Section 15 is the remarksstandard in all the DBQs.
(41:46):
Section 16 is the examiner'scertification and their
signature.
So examiner's name, title, areaof practice, their contact
information, their npi, theirmedical license and their state.
So again, that's a lengthy dbq.
I didn't touch each question,um you know word for word, but I
(42:08):
I know that als is adevastating disease and I see
the effort and appreciate theeffort that the va is doing.
However, I feel like we need tomake it consistent for for many
of the conditions that end upcausing the limitations of of
(42:29):
loss, use of loss of bowel andbladder control.
I think there's a lot morethere that we need to address.
J Basser (42:36):
You know the former CMP examiner yourself.
I don't know if you've everdone this.
Have you ever done a CMP for aperson with an injury, a spinal
injury or a paralyzed diaphragm?
You ever done one of?
Bethanie Spangenberg (42:50):
those.
I've had what they callhemiparesis, so it's just one
side versus the other, but noton both.
But I know that the pulmonaryfunction testing is not good.
J Basser (43:02):
No, here's the deal I mean.
What you've got to realize isthat even as an independent
medical examiner yourself, youcan be forceful in this.
Now, if they do an examinationand require a pulmonary function
test that the patient's gotit's already been diagnosed with
a paralyzed diaphragm.
They need to do the test whilethe person's lying down, not
sitting up.
Bethanie Spangenberg (43:23):
I've never heard of that.
What's the difference?
J Basser (43:26):
If you're sitting up, you've got gravity helping you a
little bit and you'll have alittle bit, you know, and you
blow, and you'll have a littlebit of function.
But if you're lying down, thatputs you in an actual condition,
to where you're talking, atleast a 23% drop.
That's what they need to berated on.
Not standing up you should be.
Laying down, make sense.
That makes sense, but they'regoing to do what they want to do
(43:50):
, you know.
So that makes sense, butthey're going to do it there.
They're going to do what theywant to do, you know.
So then they give you a littlejuice at the end when you go in
the box, and that little catchyou with the albuterol because
they can improve your readingbefore they get you out the door
.
Laughter, laughter, laughter.
(44:11):
No, there's certain things andcertain points that you catch on
to over time.
You know, because if you liveit, you know what was done wrong
and you know what needs to bedone right.
Bethanie Spangenberg (44:30):
So I don't know if we've talked about this
before, but at least on arecording anyway.
But I feel like to reallyappreciate where we're at now.
You have to understand how thisprocess has progressed.
So I'm in the process ofwriting the history of
compensation and pension and theprograms that have been built
(44:53):
for our veterans, starting wayfrom the very beginning.
From the very beginning it isinteresting to see you know how
the government has appreciatedthe injuries associated with war
and I think you know thehistory will talk about.
You know the economy at thattime and what the income was
(45:16):
like at that time, what kind ofcompensation was given, what was
considered.
And it was really promptedbecause I came across a legal
advertisement for an attorneygroup out of Cleveland from the
1800s and it outlined how muchveterans would get if they lost
(45:39):
a horse during the war or ifthey had other, you know, an
amputation, like the $6 thatthey would get a month for
having an amputation.
So I think it'll be interestingfor those that enjoy history
and kind of want to understandyou know how we've gotten to,
(45:59):
where we're at and the directionwe're heading, and I'm hoping
to have it's going to be about200, 300 pages, hopefully having
it done in August, so it'll bea good one.
Ray Cobb (46:12):
I'll be interested in that.
Were you aware that back duringthe Civil War, if an attorney
represented you before the VA,the maximum he could charge was
$20 of your back pay?
Bethanie Spangenberg (46:26):
I did not know that.
I haven't you know, it's noteven honestly, it's not even in
that advertisement.
I'll have to go through it.
It's got the old paper stenchand so I have to delicately like
flip those pages.
J Basser (46:38):
Oh yeah yeah, that's a bad stench.
Kind of reminds me of drivingdown through I-40 in Tennessee
in between Knoxville andChattanooga.
They've got a bunch of papermills and the whole damn place
has been right.
Yeah as you go across theOwassee River.
Ray Cobb (47:00):
Oh yeah, oh, my God, whole damn place smells that.
J Basser (47:01):
It right, yeah, you don't actually go across the uh
oasis river yeah exactly whatyou're talking about oh my god,
you gotta roll your windows upand put you put it on the
restart because you do not wantto smell that stuff.
You ever go down 75 goingtoward florida, bethany driving
that way.
When you get there make sureyou got your windows up you know
what's crazy.
Bethanie Spangenberg (47:20):
You say that and I drive to chill coffee
which is 23 minutes up the roadalmost every day and they have
mead paper mill.
It's not mead now, but the thepaper mill has ran chill a
coffee for the last 50 years, soit is on a cloudy day that that
smell is it burns.
J Basser (47:41):
It makes you sick, your stomach.
Ray Cobb (47:43):
Well, you know, right there beside that paper mill,
like you said, on a cloudy dayit's been several years ago now,
probably 25 years ago the worstautomobile collisions took
place right there in that area.
J Basser (47:59):
Foggy day right there in that area, a foggy day and
there was 128 car pileup and Ithink 33 or 34 people lost their
lives.
I heard about that.
I've been stuck in traffic inthat.
I mean we used to go intoGeorgia because Michael was
shooting TV shows and stuff andwe had to go from here to
Georgia several times and I gotstuck in that one.
(48:21):
It was raining and bad wreckand we sat there for about three
hours, isn't that correct?
Ray Cobb (48:25):
Wow, they actually have gates up to shut the
interstate.
Mm-hmm.
J Basser (48:32):
Oh, they got signs, big flashing signs up too, you
know, and it tells you, you knowcertain times.
That's why you need rain.
It's always been bad.
These new vehicles are handy nowbecause they got the front
radar.
That will save your life,because the radar will cut
(48:54):
through that fog but nothingelse will.
You can't see much but theradar.
If the car stops in front ofyou, your car is going to stop
you.
It does stop you.
Get off the road as fast as youcan, because the guy behind you
might be a tractor, trailer andnot have radar.
Bethanie Spangenberg (49:15):
You know, if I transition back to that
whole proposal for neurologicconditions, there was over and I
was impressed with the numberof comments that were submitted.
I was trying to pull it upbefore we got on here.
I can't find it now, but therewas over 50 comments from people
about the proposed changes andall but one all but one opposed
(49:44):
the changes because they did notfeel that it was going to
benefit the veteran.
And the one comment that gavethe proposed changes a complete
stamp of approval was one of thelargest advocacy groups in our
country and I am disappointed.
(50:05):
So I'm not going to say whothey are.
J Basser (50:07):
but You've got to realize.
The guy that probably wrote itwas probably sitting at his
computer at the bar.
He probably had seven rightalready.
I don't know.
Bethanie Spangenberg (50:19):
I'd like to Not the leader.
J Basser (50:47):
I don't know, I'm actually surprised we haven't.
Can I give you some advice asto get there?
Go ahead and look and go ontheir websites and look at these
organizations and start readingtheir bylaws and look where
their true allegiance actuallylies within.
Then your eyes will open andyou'll be enlightened to the new
universe.
Bethanie Spangenberg (51:07):
Our small town supports this major
advocacy group these small towns.
J Basser (51:16):
Have you got that post and the Legion post in the same
town?
Yeah, it's down the street.
Do the sheriffs come by andraid each other because they
keep bootlegging?
It happened a lot in EasternKentucky.
Ray Cobb (51:32):
Oh goodness, it happens a lot in Tennessee too.
I mean, you know Now you saidthe largest group, if I remember
correctly.
Okay, go ahead, okay, go ahead,no, go ahead.
I was going to say, if Iremember correctly the numbers
that I've seen, if you'retalking about largest membership
, the American Legion is thelargest membership and I
(51:57):
disagree with a lot of ourbylaws and I argue with them.
I mean, you know, with thisshow, along with my show, I get
a lot of attention from ourstate commander and my national
commander has come and visitedme personally to be on the show
and I have no problemchallenging them and telling
(52:17):
them how wrong they are.
It is not the American Legion.
Bethanie Spangenberg (52:23):
Oh okay, it's not the largest, but it is
a large.
Ray Cobb (52:28):
Okay, so it's the second largest, so I know who
you're talking about now.
And that goes along with whathe says about the bar.
I can relate with that one too.
Private club yeah, privateorganization.
Private, military organization.
And you know the kind ofinteresting thing when they go
(52:52):
to all three of them, all threeof your majors, when they go to
Congress and talk about how manyvotes they have to get changes
like this made, they don't tellCongress that they hadn't
cleaned up their death row inseven years.
And they're still counting guysthat have been dead for five to
(53:12):
seven years on their roll andthey're not very quick to take
them off.
I've experienced that takingtwo or three years and widows
calling me saying would youplease tell them to quit sending
my husband mail.
He's been dead for two years.
J Basser (53:30):
You know, I bet you still voted.
Ray Cobb (53:39):
Is he from Johnson County down in Texas?
J Basser (53:47):
Johnson County, the famous county, no matter what
state you're in.
Ray Cobb (53:50):
Yeah, Now we'll get a bunch of calls from some of
these guys from Texas now, sinceI made that comment.
J Basser (54:01):
No, yeah, I doubt it.
You might, but don't worry, Igot your back.
We'll send some detective boysdown there.
You used to send a bunch ofboys to Texas, but after the
Alamo they quit doing that.
What's your take on it, beth?
(54:31):
What do you think?
Bethanie Spangenberg (54:32):
uh, I mean if these changes go through,
there's gonna be a lot ofveterans screwed.
Yeah, big time big time ummaybe you know as we.
You know, I don't know the bestway to really kind of
incorporate the letter and someof the things that we discussed
and how I followed up with thosein my request, but I think the
biggest deficit or harm to theveteran is going to come to
(54:54):
these, these, uh, peripheralneuropathies that they're
proposing to change.
Yes, Um we have a DBQ.
I was actually trying to lookup you know the order of the DBQ
, so then that way I could kindof talk about the game plan.
But I know they're coming upprobably towards the end of the
year.
But I think that's actually thebiggest change that's proposed.
(55:18):
That's going to negativelyimpact the veterans is the
peripheral neuropathy.
J Basser (55:22):
My best advice if you're listening or watching the
show, if you've got a claim,even an initial claim, for any
neurological condition eitherit's radiculopathy or whatever
based on a neck injury ordiabetes, diabetic neuropathy I
would strongly recommend you goahead and get this claim in now,
before any change takes effect,because you can be rated on
today's criteria, becausethere's a cutoff date when it
(55:44):
happens.
If it happens, of course, don'tever be reactive, always be
proactive and get it in, becauseyou know if they make changes
like this, it's going to screwthe pooch one of these days.
You know the vascular onesreally got me, yeah, the changes
.
The same guy wrote it.
Bethanie Spangenberg (56:08):
Looking at the neurological conditions
order, the next one is going tobe central nervous system and
neuromuscular diseases, which islike not specifically multiple
sclerosis, but similar.
Maybe we can combine those twoor the next two, but then it's
cranial nerves and then diabeticperipheral neuropathy, then
(56:32):
fibromyalgia.
So we're not.
Peripheral nerves don't comeuntil almost the last one.
So I don't know, maybe we don'thave to go in order.
We can kind of combine and movethings around.
But if you want, john, we canjump to that one next.
That way I can get contentready.
J Basser (56:49):
We can do personal neuropathy next.
That'd be fine.
I have no problem with that,because I think mainly that's
probably going to be yourbiggest hitter when it comes to
the disability, because you knowdiabetes and injuries, I mean,
it's still the same, isn't itfor real nerves.
Bethanie Spangenberg (57:13):
Let's do that then.
J Basser (57:15):
Okay, I have no problem with that.
Well, we've got three minutesleft.
Beth, I think everybody youremail address and how to contact
you if they want to contactValor for Vet and utilize your
all's wonderful services.
Bethanie Spangenberg (57:30):
So our website is wwwvalor4vetcom.
That's Valor V-A-L-O-R.
The number four, vet, v-a-l-o-r.
The number four vet, v-e-t dotcom.
Our phone number is888-448-1011.
We're looking out for a fewthings on our website that is
(57:51):
coming as a change.
We're we're slowly trying toadd all the diagnostic codes,
kind of like similar to militarydisability made easy, but we're
focusing mainly on more of themedical aspect.
Where I'm a physician assistantand patient education when it
comes to diseases is really mypassion, so we're going to be
(58:11):
adding a lot of those articlesand veterans can look the each
blog post up by their diagnosticcode and and learn stuff about,
you know, secondary conditions,prognosis, things like that.
So big things coming in 2025.
I'm looking forward to it.
The book like I mentioned,we're going to be putting out an
interest list where people cansign up if they're interested
(58:34):
and at the book's release we'llsend out an email if they're
interested in in picking up acopy.
Yeah, out an email if they'reinterested in picking up a copy.
Yeah, give us a call.
We have disabled veterans onour team and so they love to
talk just as much as you do, sogive us a call, okay.
J Basser (58:51):
Yes, we do appreciate everybody watching and we'll do
this again next week.
This is John John Stacey.
I am the owner of theExposedNet production group now
I guess we'll call it.
And thanks to Betsy Spangenbergfor coming on and being our
guest and she'll do it againnext month.
She's a monthly guest and wework hand-in-hand with Valid for
(59:11):
Vet.
And I want to thank Mr Ray Cobbdown in Tennessee.
How you doing, ray?
Thank you for coming on, buddyand sitting with us, and with
that we'll be signing off fornow, thank you.
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