RI Veterans: Did you know? 24-08-23 (Disability claims, events, resources… ) – John A. Cianci

by John A. Cianci, contributing writer on veterans’ issues

Understanding Evidence Needed for Favorable Decision by the VA.

Question from one of our readers: I was denied service-connected disability for sleep apnea, although the VA medical center determined I had sleep insomnia and later issued me a CPAP machine? Ray, Smithfield

Answer: After discussing VA decision with you and reviewing the decision denial for sleep apnea, was considered NOT SERVICE CONNECTED. Simply put, VA decision was lack of evidence linking sleep apnea to your military service. In the decision it details your service medical records reviewed on active duty did not have any evidence medically you were having sleep issues. Moreover, the claim was filed almost 10 years after you ended your deployment in Iraq and was discharged by the Army.
Filing years later and having no medical supporting documents can be overcome. The VA has a three-prong method of determining service connected for a disability claim. Simplest explanation:

1. Does the veteran have a medical condition? Often, the compensation and pension (C & P)  exam ordered by the VA after a claim is filed will determine medical condition) 2. If a medical condition is established, how is the condition linked to the veteran’s Military service, (VA lingo “nexus”) 3. If VA determines a medical condition exists and a NEXUS is established, the VA will determine the disability compensation rating by the laws

Establishing the nexus is not required if the medical illness or condition is listed as a presumption. Example, a veteran is diagnosed with asthma almost 15 years after completing a deployment in Iraq in 2004.

Asthma is one of the presumption conditions under the PACT act. To be awarded the disability compensation for asthma per presumption, the veteran should submit evidence with the claim supporting he or she was in Iraq. Listed below are the presumptions for members of the military who served in regions and countries include: Iraq, Afghanistan, Kuwait, Saudi Arabia, Bahrain, Djibouti, Gulf of Aden, Gulf of Oman, Oman, Qatar, United Arab Emirates, waters of the Persian Gulf, Arabian Sea, Red Sea, Syria, Uzbekistan, and Egypt: 

• Asthma that was diagnosed after service
• Chronic bronchitis
• Chronic obstructive pulmonary disease (COPD)
• Chronic rhinitis
• Chronic sinusitis
• Constrictive bronchiolitis or obliterative bronchiolitis
• Emphysema
• Granulomatous disease
• Interstitial lung disease (ILD)
• Pleuritis
• Pulmonary fibrosis
• Sarcoidosis

• Brain cancer
• Gastrointestinal cancer of any type
• Glioblastoma
• Head cancer of any type
• Kidney cancer
• Lymphoma of any type
• Melanoma
• Neck cancer of any type
• Pancreatic cancer
• Reproductive cancer of any type
• Respiratory cancer of any type

Reviewing your claim you mentioned the constant waking up 2-3 times a night from the ringing in your ears. Whereas, you have already been awarded disability compensation for tinnitus, you might want to file a claim for sleep issues as a secondary for tinnitus. The best way to explain linking tinnitus is below, a veteran favorable decision in an appeal before the Board: 

Citation Nr: 1600946	DOCKET NO.  13-27 052

Decision Date: 01/11/16    Archive Date: 01/21/16	

On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa

THE ISSUE Entitlement to service connection for a disorder manifested by sleep problems, to include insomnia, as secondary to service-connected tinnitus. 

REPRESENTATION Veteran represented by:	The American Legion

WITNESS AT HEARING ON APPEAL The Veteran

ATTORNEY FOR THE BOARD A-L Evans, Associate Counsel

INTRODUCTION

The Veteran served on active duty from October 1970 to August 1972. 

This matter is before the Board of Veterans' Appeals (Board) on appeal of a January 2013 rating decision of the Des Moines, Iowa, Regional Office (RO) of the Department of Veterans Affairs (VA).

In November 2015, the Veteran testified at a Board hearing.

FINDING OF FACT

Resolving reasonable doubt in favor of the Veteran, his insomnia is caused by his service-connected tinnitus disability.
 
CONCLUSION OF LAW

The criteria for service connection for insomnia, as secondary to service-connected tinnitus, are met.  38 U.S.C.A. §§ 1110, 5107 (West 2014); 38 C.F.R. § 3.102, 3.303, 3.310 (2015).

REASONS AND BASES FOR FINDING AND CONCLUSION

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C.A. § 1110 (West 2014); 38 C.F.R. § 3.303 (2015).  "To establish a right to compensation for a present disability, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement."  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Although this is the general standard for service connection, the Veteran primarily contends that he has sleep problems as a result of his already service-connected tinnitus.  Thus, in addition to the elements of direct service connection, service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310 (2015).  Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439, 448 (1995).

The Veteran contends that he has developed a sleep disorder as a result of his service-connected tinnitus.  The Veteran asserts that he awakes three to four times a night because of the noise produced by his tinnitus.  He has not set forth a theory of direct service connection and his service treatment records do not reference any sleep problems.  

An August 2001 private treatment record shows that the Veteran was diagnosed with obstructive sleep apnea.  The planned use of a continuous airway pressure (CPAP) machine was noted.  Subsequent private treatment notes, to include records dated in January 2008, October 2010, February 2011 and February 2012 indicate continued treatment for obstructive sleep apnea and the use of a CPAP machine.  

A January 2011 VA treatment record notes that the Veteran's tinnitus interfered with his sleep.  An April 2011 VA respiratory examination report reflects a diagnosis of obstructive sleep apnea and notes that the Veteran's sleep disorder was due to a general medical condition (tinnitus). 

An August 2011 VA medical opinion report reflects that the Veteran's claims file had been reviewed and the VA examiner noted a December 2010 VA treatment note which revealed that the Veteran had a body mass index of 32.76.  The VA examiner opined that the Veteran's claimed condition was less likely as not proximately due to or the result of the Veteran's service-connected condition.  The VA examiner noted that the Veteran's obstructive sleep apnea was more likely than not secondary to obesity which is a known significant risk factor of obstructive sleep apnea.  He noted that there was no known relationship between tinnitus and obstructive sleep apnea and that the December 2010 VA treatment note reported that the Veteran's tinnitus did not interfere with sleep.  

A May 2012 private treatment note shows that the Veteran reported suffering from sleep latency due to his tinnitus.  An assessment of insomnia was provided.

A June 2012 private note from Dr. Wxxxxxxx indicates that the Veteran had experienced sleep apnea and used a CPAP machine.  The private doctor stated that the Veteran's complaints regarding tinnitus in his sleep disturbance had to do with the initiation of sleep, which would be insomnia.  He stated that tinnitus had been associated with insomnia.  He noted that the relationship between the two is not well defined, but noted that people had reported that tinnitus made it difficult for them to sleep.  He stated that the two had to go hand in hand and they tended to magnify the psychological effects of each other.  He opined that the Veteran's tinnitus was impacting his sleep disturbance and that the association of tinnitus and sleep disturbance was irrefutable.  

In another private note received at the RO in June 2012, Dr, Kxxxxx noted that she had been seeing the Veteran since 2004.  She noted that she concurred with a denial regarding a connection between the Veteran's sleep apnea and tinnitus; however, it has been established that part of the Veteran's sleep disturbance, insomnia, was because of his chronic tinnitus.  

In consideration of the evidence of record, it appears that the medical evidence of record is in equipoise as the possible relationship between the Veteran's service-connected tinnitus and his sleep problems.  The VA examiner's opinion weighs against the claim, but the opinion seems to focus primarily on the physical disability of sleep apnea.  On the other hand, the two private opinions distinguish between the Veteran's sleep apnea, which they do not necessarily indicate is related to tinnitus, and the Veteran's insomnia.  The two opinions reflect a causational link between the Veteran's tinnitus and that specific sleeping problem.

The mandate to accord the benefit of the doubt is triggered when the evidence has reached a stage of equipoise.  In this matter, as there is competent medical evidence both in favor of and against the claim of secondary service connection, the Board is of the opinion that this point has been attained.  38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001).  As such, after resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran has a sleep disorder-best characterized as insomnia-that is related to his service-connected tinnitus.  Accordingly, service connection is warranted for insomnia.

ORDER       Service connection for insomnia, as secondary to service-connected tinnitus, is granted. 

____________________________________________
RYAN T. KESSEL
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs

Too many veterans believe just because the VA determined a sleep disorder and issued the veteran a CPAP, the veteran will be entitled to disability compensation. Not the case at all. Unless The sleeping disorder is documented when the veteran is on active duty or within one year after discharge, the burden of proof rests with the veteran to link the sleep disorder to their service.

The aforementioned should give you a flavor of the evidence needed to overcome the initial denial of sleep apnea and linking to current disability. Evidence which included (1) statement and testimony before the Board from the veteran, and (2) opinions from private medical personnel. Moreover, reading the above case you see the veteran’s only active duty time was in the 70s, however, the claim was filed over 30 years after the veteran was discharged. For sure, boring reading, but a great example of a veteran not giving up and successfully winning on appeal to the Board.

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EVENTS

August 2023

August 26, 2023

4^th Annual Calling All Veterans Day, West Warwick Civic Arena, 100 Factory Street, West Warwick RI, 10:00 am-1:00

August 26, 2023 Rhode Island Military Vehicle Collectors Club (RIVCC), 2111 Plainfield Pike Johnston RI. 

August 26, 2023, Saturday Morning , Narragansett Town Beach, VetSurfEndless Summer Session. The event is FREE to veterans. The link to sign up is    https://vetsurf.org/    

If  you know of any other veterans/active-duty military (especially) or volunteers who may interested in coming, please forward this email to them –You don’t need to be a surfer to join in & this is a FREE EVENT. I look forward to seeing you all there and thanks for your support.

September 2023

Sept 8-10, 2023  Rocky Point State Park, Warwick American Veteran Traveling Tribute & Traveling Wall, remembering 209 Rhode Islanders who lost their lives in Vietnam War. Donations and sponsorship will support Operation Stand Down Rhode Island. Memorial opens 8am Friday – 5 pm Sunday. Saturday September 9 2:09-2:30 and Sunday 2:09-2:30 pm reading of 209 Rhode Island names, For more information visit OSDRI’s Event Page, www.OSDRI.org

September 14,-15 Veteran Event, Johnston RI, Center, located at 1010 Hartford Avenue in Johnston RI. Operation Stand Down Rhode Island (OSDRI) is set to kick off its 32nd annual Veteran Assistance Event on September 14th at 8 a.m. This Veteran Assistance Event will be held at OSDRI’s Veteran Service Center located at 1010 Hartford Avenue in Johnston. Services will be available from 8:00 – 4:30 on Thursday 9/14, and 8:00 – 3:30 on Friday 9/15. 

“Since its inception in 1993, the annual event has provided thousands of veterans with access to important services including health, dental, and substance abuse care, as well as employment, legal, and housing services. After holding a scaled back event during the pandemic in 2020, OSDRI expects a full roster of service providers this September.” said Erik Wallin, Esq. Executive Director of Operation Stand Down RI.

The event will be held at OSDRI’s Veteran Service Center, located at 1010 Hartford Avenue in Johnston. Veterans may access the location via RIPTA bus Route 28 which operates out of Kennedy Plaza and stops at the corner of Hartford and Bordon Avenue. Those arriving via their own vehicle must park and take a shuttle from behind the paved parking area ACROSS from Tri-County Community Action Agency: 1133 Hartford Avenue, Johnston, RI 02919

November 2023

November 5, 2023; Veterans Inc 2023 Run4Heroes 5K Road Race, Registration begins at 8 a.m , race begins at 10:30 a.m at the start/finish line in front of Wormtown Brewery, on Shrewsbury St., Worcester, MA. 

all participants will indulge in a post-race celebration featuring food, a complimentary beer from Wormtown Brewery, live music, exciting prizes, and more! If you can’t make it in person this year, we are offering a virtual sign-up option as well! Just run a 5k before the deadline, submit your times, and we will recognize your participation and honor the virtual winner alongside the in-person honorees.

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RESOURCES  & ongoing groups 

Below are all the groups the Providence Vet Center is currently offering.  As this list changes, I will provide updates. Please send me any questions that you may have, thank you for your time! 

***All Vet Center Groups require that the Veteran be enrolled with the Vet Center prior to attending. To check eligibility or for questions, please contact the Vet Center at (401) 739-0167 or reach out to our Veteran Outreach Program Specialist (VOPS) via email at [email protected]*** 

Post-Traumatic Stress Disorder Group (PTSD) – 2nd and 4th Tuesday of the month from 2:00 – 3:30 p.m. (Group is only active September through May) 

Global War on Terrorism (GWOT) and Vietnam Veterans PTSD Group – 2nd and 4th  Wednesday of the month from 9:30 – 11:00 a.m. 

Vietnam Veteran PTSD Group – 1st and 3rd Monday of the month from 10:30 – 12:00 p.m. and 5:30 p.m. – 7:00 p.m. 

Art Expression Group – Every Thursday from 9:00 – 12:00 p.m. 

Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) Group – Every Wednesday from 11:00 – 12:00 p.m. 

Stress Management – Every Thursday from 9:00 – 10:00 a.m. 

Low Impact Walking  Group – Every Tuesday from 9:00 – 10:00 a.m. 

Guitar 4 Veterans – Every Wednesday from 7:00-8:30 p.m. 

Monday Mindfulness Group – Every Monday from 10:00 – 11:00 a.m. 

Yoga Group – Every Friday from 12:00 – 1:00 p.m. 

Moral Injury Group – Every Friday from 10:00 – 11:00 a.m. 

Modern Warrior Support Group – 1st and 3rd Monday of the month from 2:30 – 4:00 pm. 

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Travel/Entertainment for Veterans

Free Golf,  Goddard Park Golf Course Fee Exemption for Totally Disabled Veterans: Rhode Island resident Veterans who have a 100% permanent and total, service-connected disability rating from the VA are exempt from paying any fees to play golf at the Goddard Park Golf Course. For more information call the Clubhouse at Goddard Memorial State Park from April 1st through the 3rd Saturday in November at 401-884-9834 or year-round at Division Headquarters at 401-667-6200.

Free Rhode Island Hunting and Fishing Licenses for 100% Disabled Veterans: A Veteran who has a 100% disability rating from the VA is eligible for free Rhode Island hunting and fishing licenses.

No cost licenses are available if you are:

• over 65 AND a Rhode Island resident
• a veteran with 100% disability status from the Department of Veterans Affairs
• a person with 100% total disability status from the Social Security Administration

To apply in person at DEM, please bring a photo ID and an ORIGINAL DOCUMENT OF THE FINAL DECISION(S). Office hours are 8:30 a.m. to 3:30 p.m. Monday through Friday. (directions)

To apply by mail, please complete an application and mail the application and a copy of your photo ID and the ORIGINAL DOCUMENT OF THE FINAL DECISION(S). Please allow two weeks for processing.

The address to obtain your license in person or by mail is:
DEM Licensing Office
235 Promenade Street, Room 360
Providence, RI 02908
(401) 222-3576

To purchase online, you will be required to certify that you have an ORIGINAL DOCUMENT OF THE FINAL DECISION(S). You will also be required to enter the date the decision expires. The Department will audit compliance with the certification and may, at any time, request a copy of the current DOCUMENT OF THE FINAL DECISION(S). Failure to submit the documentation by the date requested may result in the suspension of your fishing and hunting license. Also, Rhode Island General Law 11-18-1 prohibits giving false documents to an agent, employee, or public official. The penalty is a misdemeanor punishable by a fine of up to $1,000 or imprisonment up to one year.

Rhode Island Hunting and Fishing Benefits for Service Members and Veterans: Rhode Island offers several hunting and fishing benefits to Service members and Veterans. A short description of each is listed below. Applicants are required to show documentation proving eligibility when they apply:

• Active-Duty Service members – Military ID
• Veterans – DD214
• Disabled Veterans – VA Disability Certification Letter ( Contact VA office)

Applicants can apply online at Rhode Island Outdoors, in person at the Rhode Island Department of Environmental Management, Office of Boating Registration and Licenses in Providence (Monday through Friday 8:30 a.m. – 3:30 p.m.), at an Authorized In-Person Sales Agent, or they can mail applications to:

Rhode Island Department of Environmental Management
235 Promenade Street, Room 360
Providence, RI 02908
Phone: 401-222-3576

Learn more about FREE Rhode Island Hunting , Fishing, State Parks, and Golf  Benefits for Service Members and Veterans

https://dem.ri.gov/about-us/dem-offices/boating-registration-licenses/rhode-island-outdoors#:~:text=If%20you%20qualify%20for%20a,that%20issued%20the%20disability%20decision.

Free Rhode Island State Park Passes for 100% Disabled Veterans: Rhode Island offers the State Park Disability Pass for use at any state-owned recreational facility to disabled Veterans who have a 100% service-connected disability rating from the VA.

The State Park Disability Pass authorizes free admission and parking but does not exempt the following:

• Licensing fees
• Camping fees
• Picnic table fees
• Specialized facility use fees
• Use of equestrian areas
• Performing art centers
• Game fields fees
• Mule shed fees

If the disabled Veteran cannot drive, the vehicle transporting the Veteran will not be charged.

Veterans must apply in person at the Rhode Island State Parks and Recreation Headquarters and are required to show official documentation (dated within the past year) from the VA that states they have a 100% service-connected disability.

Rhode Island State Parks and Recreation Headquarters
1100 Tower Hill Road
North Kingstown, RI 02852
Phone: 401-667-6200
Email: [email protected]

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Discounts for Veterans 

Services 

No Problem Plumbing and Heating LLC:  15% military discount, ask for Ron Gaynor, (401) 568-6666. Veterans must provide proof of eligibility with a VA Card, VA ID Card, or RI State license with veteran identification. 

Restaurants 

Applebee’s – Military Discount. With more than 2,000 locations, Applebee’s is a family grill restaurant. Applebee’s gives 10% off for active duty and veteran. Last verified 07/31/2022. 

Denny’s – Hartford Ave, Johnston offers 10% discount for veterans and active duty. Denny’s is a table service diner-style restaurant chain. Last verified 07/31/2022. 

Outback Steakhouse – 10% Discount to active and veterans. Last verified 07/28/2021 

99 Restaurant & Pub – The 99 Restaurant & Pub offers a 10% military discount to members of Veterans Advantage. Available at select locations only. Bring valid military ID 

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Retailers 

Advance Auto Parts – 10% for Active Duty, Veterans, and families. Last verified 07/28/2021 

Bass Pro Shops – Offers a 5% discount to active-duty military, reservists, and National Guard. Sign up and verify your status online or bring your military ID when you shop at your nearest Bass Pro store (source). 

BJs Wholesale – Reduced membership fee. BJ’s offers all military personnel over 25% off their Membership. Last verified 07/28/2021 

Lowes – Enroll in the Lowe’s Military Discount Program to activate your 10% discount – “Our way of saying Thank You” to our active duty, retired and military veterans and their spouses with a 10% discount on eligible items. Verification of your military status is fast and easy through our partner,  ID.me. 

ID.me is our trusted technology partner in helping to keep your personal information safe. 

GameStop – is offering a 10% in-store Military discount on all pre-owned products, collectibles, and select new products. Available to current and former Military members who bring any valid proof of service or when they verify through ID.me 

Home Depot – Offers a 10% off military discount on regularly priced merchandise for in-store purchases for active duty, retired military, and reservists at participating locations. Customers are required to show a valid government-issued military ID card to redeem this offer. 

Kohls – 15% discount offers for active military, veterans, retirees, and their immediate family members a 15% discount on purchases made on Mondays, in store only. In order to receive the military discount, eligible customers must present proper identification along with any tender type. 

Jiffy Lube – HONORING VETERANS ALL DAY EVERY DAY! – We didn’t want to wait for Veteran’s Day to express our appreciation and gratitude for your service. That’s why every Team Car Care owned and operated Jiffy Lube® service center is offering our BEST discount of 10% OFF as a “Thank You” to the men and women of our Armed Forces for their service to our country. *Disclaimer*- I.D. required. No coupon is required. Excludes batteries and brakes, alignment, and diagnostic services. Available only at 3 select locations listed below: 

Tioque Ave, Coventry RI – Bald Hill Road, Warwick RI – Park Ave, Cranston RI 

Michaels – offers a 15% off military discount on the entire in-store purchase including sale items for active duty, retired military, guard, reservists, veterans, and family members. How to get – 

1.    Create an Account. Log in or create a Michaels Rewards account. 

2.    Get Verified. Provide your military information to get verified instantly. 

3.    Go Shopping! To use your discount online and in store, just sign into your account or provide your Michaels Rewards phone number at checkout. 

O’Reilly Auto Parts – 10% discount on in store items for Active Duty, Veterans and families. Last verified 3/4/21. 

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If you are a retailer and or a veteran aware of a business not listed above, please forward to: [email protected]:  the business’s name, location, and military and veteran discount offered. 

If you have an event, meeting, other pertinent veteran information, or email questions or help needed, contact the Italian American War Veteran Service Officer, John A Cianci, [email protected], ITAM Office 1-(401)677-9VET(9838) 

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To read all columns in this series go to: https://rinewstoday.com/john-a-cianci/  

John A. Cianci is a Veteran Service Officer. Retired, U.S. Army MSgt., Persian Gulf War and Iraq War combat theater.

Cianci, a combat disabled Veteran, served in Desert Shield/Storm and Operation Iraqi Freedom. His awards include Bronze Star, Combat Action Badge, Good Conduct, and others.

Cianci belongs to numerous veterans organizations – Italian American War Veterans, American Legion, Veterans of Foreign War, and many more organizations. He is an active volunteer assisting veterans to navigate federal and state benefits they have earned. He is Department of Rhode Island Department Commander Italian American War Veterans and Veteran Service Officer.

He is a graduate of Roger Williams University (BS Finance), UCONN business school* (Entrepreneur Bootcamp for Veterans), Solar Energy International Residential, Commercial and Battery Based Photovoltaic Systems certificate programs, numerous certificates from the Department of Defense renewable energy programs, including graduate of the Solar Ready Vets Program.