vlb-all-products

vlb-c-file-manual


  • Topics

  • Member Statistics

    • Total Members
      15,882
    • Most Online
      3,604

    Newest Member
    Recan
    Joined
  • Forum Statistics

    • Total Topics
      61,112
    • Total Posts
      394,126
  • Posts

    • VYNC said" "The C&P examiners surely must realize that they don't work at the VA of 20 years ago. Back in the 90's, I had no way to know if the examiner was being thorough or not. Now, we are empowered with knowledge here from Hadit and also are fortunate enough to have the DBQ's and C&P exam questionnaires available to us online." That is SO true! In the late 1980s I realized how much the RO could manipulate what a C & P actually said. They deliberately left out a final statement by a C & P examiner to deny my DIC claim.11997. He had speculated a ridiculous Cause of death , but what the RO failed to add was ,that he wrote, "that an autopsy could have ruled out."  They did have the doctor's name in the denial so I called him up and raised Hell...to learn that VA not only did  not give him the 6 page autopsy (which they had) but also what it revealed would have completely changed his opinion. He then got angrier than I was and I could tell the VA had pressured him for exactly what they expected from him.He sent me a copy of his exact opinion that they had and that gave me the evidence I needed to keep fighting them and draw them out on the autopsy. (They also removed it from the files they sent to the General Counsel. I fought back on that and when the VA  got the 12th copy of it , OGC awarded the FTCA case and then after another RO denial, the RO awarded DIC under 1151. It is the C & P exam that controls our claims. As Vync said, because we can get copies of it these days, the R0s cannot get too creative with the results. But the fact remains that C & P doctors are paid by the VA. If the APRN rule goes into affect, I guess AP nurses will be doing  the C & Ps. The 2 main reasons, in my decades of experience, that most claims are denied is that: the evidence does not establish a nexus ( this is really the claimant's responsibility) or that a C & P was done improperly or by someone with no expertise to adequately do it. One more reason...secondaries even if absolutely obvious, need a strong C & P opinion but  many of those claims need an opinion from a real doctor.(a non- VA doctor with expertise in the field) Unfortunately C & P exams do not fall under the malpractice regulations. I have fought back vigorously every bogus posthumous C & P exam they ever did on my claims. They knew the veteran could not speak for himself or have input into those C & P exams,because they killed him in 1994 with outrageous piss poor medical care. Pres.Clinton said months before he died that VA was the Best Government- run health care system in the world.My husband almost dropped his 1151 claim when we heard that on TV. Since then the malpractice stats of the VA have gotten much worse. Maybe the medical incompetence has not really gotten worse, but for sure, veterans and their survivors have gotten smarter because of the internet and their ability these days to file and prove malpractice claims, if it has occurred, and their willingness to get an opinion from a real doctor.(IMO/IME)              
    • Your Appeal is at the BVA, just no Docket # yet, right. You do have a copy of your husbands C-File? We need to see a redacted copy of the initial Denial and the "Statement of Case." What exactly is your "Evidence of Record?" Many vet's that get caught up in the VA Appeals process, get a negative attitude, right away. They believe that there is a VA conspiracy to Deny and/or limit their Comp Benefits. VA Raters base their Award/Denial Decisions on "Evidence of Record," if the provided Evidence doesn't substantiate the claim, you get a Denial. That's not to say Rater's don't make errors, but a conspiracy (takes more than 1 person) to Deny is hard to believe, these are mid-level VA Employees. What does your VSO say about your Evidence regarding the linkage to CAD or Kidney Disease? Which condition is most likely the causative SC for the Secondary issue? Could you post redacted Dr's Clinician Notes, or other Medical Evidence supporting your claim?  Semper Fi
    • Andyman is correct, i ALWAYS ask that all my issues are taken care of through the VA. I refuse to even accept the Choice program even though it is available to me. My C&P was done by a VA psychologist, i was literally approved the day after. For those of us who are not yet P&T 100%, it is wise to always use the VA's system, Rating Officers really don't listen to the opinions outside of the VA anyways. Make your case stronger by always using their system to get what is Owed
    • To add to Ham's intel, you also would get an additional 10% added to any bilateral rating, that is, if you have a SCD involving opposing body parts, L and R side, doesn't have to be both knees, could be L knee and R ankle...how that works is like this 10% + 10%...10+9=19, bilateral factor would be 10% of that, or 1.9, added to the 19 + 20.9, or rounded to 21. And more importantly, if you have dependents, 30% is the magic number because you get an allotment for each one, at that point.
    • Chris Not sure, off the top of my head I actually can't recall either way! But I do believe any in house C&P exam should be on there, however, if it was done by a contracted provider it will not be on there.  Anyone with better intel on this can speak to it. Semper Fi





PapaJahn

Award Letter Received...confused

6 posts in this topic

Well, it finally happened.....

I received my rating letter and I can't complain! I do have a question that the VA (800#) refuses to clarify.

Background info:

17 April 09: Filed claim

May-Aug 09: Butt-load of CP exams

30 June 09: Retired USAF

24 Sep 09: Received check from US treasury...no annotation as to reason (assumed it was VA Comp)

25 Sep 09: Called VA 800# and confirmed check was first VA comp. Woman stated decision letter would soon follow.

28 Sept 09: Received decision letter...100% with SMC added, effective 1 July 09

Here's where I am confused...called 800# a couple of times and have gotten conflicting anwers.

The first page has my monthly entitlement amount- $$$$$, followed by the payment start date - Aug 1 2009.

The following page states: "Your payment begins the first day of the month following your effective date. You will received a payment covering the intial amount due under this award, minus any withholdings, in approximately 15 days. Payments will then be made at the begining of each month for the prior month. For example, benefits due for May are paid on or about June 1."

If logic prevails.....I was entitled to benefits for July, August and now September. Since the first check wasn't cut until 23 Sept it should have been for July and August entitlements....correct???

Well, my first check was equal to one months' benefit....which month it was for wasn't annotated on the check. So, I call the infamous 800# to seek clarification. Woman stated that check cut was for Aug and I wasn't entitled to July because of the "payment start date" wasn't until 1 Aug. After discussing MY interpretation of the letter, she backtracked, agreed, and stated another check had been cut and was in the mail. She stated Oct 1st payments hadn't been processed for anyone yet, so this check must be the other month of retro pay and I that I would receive another check on/about Oct 1st...3 months, 3 checks.

Great...issue solved...so I thought.

Got another check in the mail today...just as she promised. One small glitch....the check is dated for 1 Oct and is annotated with "09 Va Comp for Sep".

So, back to the 800# again, different representative. I repeat the process from the previous conversation.

The young man I spoke with didn't have a clue. At first he disagreed with me...then he agreed...then contradicted himself by saying the check received today was both back pay AND October's payment...A complete idiot. I asked if I could have his name and speak to his supervisor he said NO to both and I could just call back to get another representative. I repeated my position and he says "OH!" and agrees, once again. He places me on hold to double check and then someone else gets on the phone and "tells me how it is". I was stunned at her rudeness. She stated the check received today, dated 1 Oct is for my September entitlement. The previous check (dated 23 Sept) was for Augusts' entitlement and that I am not entitled to anything for the month of July, because my payment start date wasn't until Aug 1st. She refused to speak any further and hung up on me.

So, i guess their final position is that the start date of Aug 1st IS the same as the effective date and than I am not entitled to any comp for the month of July.

Soooo, for any of you patient enough to read through my ramblings...are my assumptions correct or are these VA reps correct? If I am correct what do I have to do to get the rest of my retro pay?

I really hope I made myself clear and thank anyone for their input on this issue.

PapaJahn

Share this post


Link to post
Share on other sites



Well, it finally happened.....

I received my rating letter and I can't complain! I do have a question that the VA (800#) refuses to clarify.

Background info:

17 April 09: Filed claim

May-Aug 09: Butt-load of CP exams

30 June 09: Retired USAF

24 Sep 09: Received check from US treasury...no annotation as to reason (assumed it was VA Comp)

25 Sep 09: Called VA 800# and confirmed check was first VA comp. Woman stated decision letter would soon follow.

28 Sept 09: Received decision letter...100% with SMC added, effective 1 July 09

Here's where I am confused...called 800# a couple of times and have gotten conflicting anwers.

The first page has my monthly entitlement amount- $$$$$, followed by the payment start date - Aug 1 2009.

The following page states: "Your payment begins the first day of the month following your effective date. You will received a payment covering the intial amount due under this award, minus any withholdings, in approximately 15 days. Payments will then be made at the begining of each month for the prior month. For example, benefits due for May are paid on or about June 1."

If logic prevails.....I was entitled to benefits for July, August and now September. Since the first check wasn't cut until 23 Sept it should have been for July and August entitlements....correct???

Well, my first check was equal to one months' benefit....which month it was for wasn't annotated on the check. So, I call the infamous 800# to seek clarification. Woman stated that check cut was for Aug and I wasn't entitled to July because of the "payment start date" wasn't until 1 Aug. After discussing MY interpretation of the letter, she backtracked, agreed, and stated another check had been cut and was in the mail. She stated Oct 1st payments hadn't been processed for anyone yet, so this check must be the other month of retro pay and I that I would receive another check on/about Oct 1st...3 months, 3 checks.

Great...issue solved...so I thought.

Got another check in the mail today...just as she promised. One small glitch....the check is dated for 1 Oct and is annotated with "09 Va Comp for Sep".

So, back to the 800# again, different representative. I repeat the process from the previous conversation.

The young man I spoke with didn't have a clue. At first he disagreed with me...then he agreed...then contradicted himself by saying the check received today was both back pay AND October's payment...A complete idiot. I asked if I could have his name and speak to his supervisor he said NO to both and I could just call back to get another representative. I repeated my position and he says "OH!" and agrees, once again. He places me on hold to double check and then someone else gets on the phone and "tells me how it is". I was stunned at her rudeness. She stated the check received today, dated 1 Oct is for my September entitlement. The previous check (dated 23 Sept) was for Augusts' entitlement and that I am not entitled to anything for the month of July, because my payment start date wasn't until Aug 1st. She refused to speak any further and hung up on me.

So, i guess their final position is that the start date of Aug 1st IS the same as the effective date and than I am not entitled to any comp for the month of July.

Soooo, for any of you patient enough to read through my ramblings...are my assumptions correct or are these VA reps correct? If I am correct what do I have to do to get the rest of my retro pay?

I really hope I made myself clear and thank anyone for their input on this issue.

PapaJahn

Share this post


Link to post
Share on other sites

Papa,

I'll try to explain this and I think when done, you'll be able to understand. I was somewhat perplexed, not unlike yourself, when I received my first check. My confusion was for the same reason as yours. However, after reading this letter a few times, the light bulb finally went on, to borrow the famous analogy.

"Your payment begins the first day of the month following your effective date. You will received a payment covering the intial amount due under this award, minus any withholdings, in approximately 15 days. Payments will then be made at the begining of each month for the prior month. For example, benefits due for May are paid on or about June 1."

This can be confusing as Hell. Your effective date is July, and payment, as stated above, will begin in August, the first day of the month. Your confusion, as it appears to me is that you believe you should be paid for July also, inasmuch as this is listed as the effective date. However, such is not the case. If you would have received your first payment in September, instead of August,you would have a legitimate claim for Sep and Aug, because payment was scheduled to begin in August, first month after the effective date. So, in essence, you have to think of July as merely a date for establishing all further payments and that July itself is not a month in which you will be paid for.

Still confusing, I'm aware, but I hope this helps somewhat anyway.

Share this post


Link to post
Share on other sites

I have been on SMC for the past 6 yrs been a 100% now I have recievd a 70% rating I have a appeal in for housebound should I do a new claim on the 100 and 70 or let it ride? Also in my award letter it stated they made a unmistakable era and they changed the statis to 38 usc 1114 subsection p and 38 cfr 3 350 f3 at intermediate between subsection 1 and subsection m what does this mean please

Edited by Lenkl

Share this post


Link to post
Share on other sites

Lenkl asked:

“I have been on SMC for the past 6 yrs been a 100% now I have recievd a 70% rating I have a appeal in for housebound should I do a new claim on the 100 and 70 or let it ride? Also in my award letter it stated they made a unmistakable era and they changed the statis to 38 usc 1114 subsection p and 38 cfr 3 350 f3 at intermediate between subsection 1 and subsection m what does this mean please”

The regulations for SMC should have been enclosed with the decision. There is more info if you google M21-1MR Part IV, Subpartii, Chapter 2, Section H.

I am confused too by your question. It looks to me like you sure do get a higher level of SMC than the “S:” award but did the VA's Clear and unmistakable error you said they referred to, give you more SMC comp

under SMC 'P 'or less under the intermediate level l, to M?

If their CUE on themselves didn't favor you, that might well be something to disagree with and include in any appeal.

Have they awarded you Aid and Attendance already?

Share this post


Link to post
Share on other sites

My appeal was for a higher level aid and attendance it has been in for three years I had a severe nervous break down being stuck in this bed and the pain I am in I am rated 100%post tramatic brain injury with complex siezure disorder 40% right and left loss of use of legs 50% loss of use of right upper body shoulder arm and hand 40%for broken pelvic I fell and they had to put a plate and screws in also 40%ddd for my back and 40% ddd in my neck I was given a increase of 70% for my mental depression What I need to know is do I make a new claim on the grounds of a 100% plus 70% or let the appeal go thru 2 or 3 more years. As I wrote I think I am a M the way they said it is the way I wrote it I also do not know how to ask or get to level N. Thank you for writing back.PS I have several 10 and 20% ratings I feel they do not matter so I did not break them down. Yes I have aid and attendance.

Edited by Lenkl
1 person likes this

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now