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How to Get your VA C-File




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    • Full Knee Replacement
      First, if you  have newer x-rays from outside the VA, get them and the reports into your VA med file. The distance from the VA hospital initially is not as important as the distance to a local VA outpatient clinic. But, once you convince the clinic PCP then outside care (consult in VA speak) can be authorized, since the VAMC is farther away than 40 miles. 
    • Dro Review Processing Time
      I sent in an NOD requesting DRO review about two months ago.  Nothing appeared on ebenefits so I sent an ISIS message.   Took them 2 weeks to reply  (ignore their note that days reply would be sent in 5 workdays)   Return meggage said NOD was received but ebenefits is a little behind   Message said a letter was sent to me asking if I wanted DRO review.  Msg said ignore letter because I already asked for DRO in NOD. Here's  the killer.  Average time for DRO review    631 days
    • Code Sheet
      After reading my code sheet I saw I have one of those. I'm rated on my ankle as 5020-5271. It's also static.  To me the code sheet eases the Veterans MNF. I know what my codes are and I know that my contentions are either static or non-static.  This shoulf not be a secret to is at it is vital information. Nor should this be a huge issue to get. 
    • Auto Adaptive Reimbursement
      I'd try to get something in writing concerning changes/refusals, than, "run the flag up the pole" any way that I thought would help. Automatic transmissions are more or less standard these days, so I'd not be surprised about that.  Bureaucratic screw ups in budgets are not a valid reason for failing to provide benefits required by title 38. Looking at things from a different perspective, some vehicle options are often listed as options,even though they are really "standard". A/C and automatic transmissions are just two. Another possible go-around is that different trim levels of the same vehicle have different options as "standard". You could possibly buy a base version, and add options at extra cost, or an up trim version with the "options" already included as "standard". It may be that the VA is looking at what the "normal" buyer options are, and trying to avoid paying for them.  
    • CUE? Not using SMR?
      Yes, if they notice the CUE they can adjust on their own.  I just had the EED adjusted on my initial claims for asthma and left ankle, the rater looked at my entire record while processing my unadjudicated claim for diabetes.  He immediately file a cue and adjusted the EED.  I didn't have to do anything for the EED/CUE. However, my ED was actually a CU they started them in 98 vs. 97.  
    • C&P Exam Results, WTH is going on, Please Help!!!
      Agree with killemall. You got this Navy04, we can't wait for you to come back here and say DONE!    
    • Code Sheet
      Thanks Asknod My problem is finding out the code for the disability.?? PTSD Code has it at 9411&9435 Code for Unspecific Depresssive Disorder VA Notes from  PCP  has PTSD  As : SCT47505003  My Sleep Apnea Notes has the code as SCT 73430006, Some of these I get confused with Insurance Codes  for Insurance Purposes. Jbasser & Jerrel Cook had a blog talk radio show on these rating codes Last year some times Maybe I'll recheck the Archives Shows. I tried to look up the code for OSA but never found it. just the SCT #73430006..?  And I have a Boo-Coo List of NSC disability's/contentions.  with the SCT# at the end of them
    • Auto Adaptive Reimbursement
      Update. My friend talked to the head of prosthetics in Tucson(kristine) and she informed him that the VA will not cover some items like power options,automatic transmissions and a few others.(I can't remember the list of things he told me).These were all covered by the VA previously.
    • NOD / DRO or TARP?
      All, Thank you for the response's. Due to me posting all of my documents intermittently, there seems to be some confusion with the timeline and issues. I will attempt to run thru this chronologically and repost all documents including my 2015 decision which I had not previously posted and answer all questions. March 2009- Filed original Claim for the following issues and received results October 2009 (see 2009 - Rating Sheet below) I do not have the entire decision packet: TBI - 10 % SC Residuals, gallbladder removal - 0% SC Back Condition - declined SC Psoriasis - declined SC PTSD - declined SC / Stressor conceded as combat action badge. October 2010 - Filed NOD / DRO for PTSD March - 2011 - Appeal decision received. I never stated that PTSD was due to MST. The paragraph on page 2 of 2011Appeal decision below is just the last part of 10 pages that I cut out covering rules and US code that they sent in the letter. The actual decision starts at the bottom of that page. Results: PTSD declined - I did not submit any new evidence. Diagnosed as "adjustment disorder with mixed anxiety and depressed mood". Blamed on me worrying about my husband returning to Iraq, even though he had just returned??? October 2014  - Initiated following claims: (I had transferred to the North Texas VA and had finally began receiving treatment after being fed up with OKC VA. I live in southern Oklahoma, so its a drive for me to go to either one) PTSD - Re-open Claim. TBI - Request for increase. May 2015 -  I reported for C&P exams at the Dallas VA clinic for PTSD and TBI. I'm not sure if this is relevant, but I received a call while my husband and I were driving there stating that the TBI examiner had to leave early and they would have to re-schedule that exam. I protested because it is a 3 hour drive. They called me back 10 minutes later stating that he would conduct the exam. He seemed pissed the whole time. His notes stated that No TBI residuals were present.  This is also the exam where the PTSD screener stated "However, it should be pointed out that most of the symptoms the veteran described during today's MH examination certainly those common to a PTSD diagnosis- she also described during her 7/8/09 Initial PTSD examination, in Oklahoma City, three years PRIOR to her son's illness."  ( see 2015 C&P exam notes below) June 2015 - Latest decision received. Results (see 2015 - decision part 1 &2 below): TBI - Decreased to 0% SC PTSD - 50% SC May 2016 - Wondering what my best next COA should be? Would like to get PTSD effective date back to 2009 and get TBI increased to at least percentage it was before. I have about 50 days to file my NOD. Q&A: Berta: What did the C & P doc diagnose you with? 2009 - TBI (SC) and adjustment disorder with mixed anxiety and depressed mood (not SC) 2015 - No TBI residuals and PTSD w/ major depressive disorder.   Berta: Have you googled the doctor who did the C & P? I do not know the Doctor's name from 2009. But I have found several articles referring to a Dr. Gail Poyner who was conducting PTSD exams at OKC VA at the time. She was fired from the VA in 2010 for applying test to Veterans to see if they were malingering or faking. Her research paper can be found here: http://link.springer.com/article/10.1007%2Fs12207-010-9076-x?LI=true I would like to have my C-File to see if she conducted the evaluation.   Gastone: What did you claim as the PTSD Stressors in your 09 app for PTSD? Combat Action Badge   Gastone: The 1st Denial, discussed "No Evidence of Personal Assault," MST? No MST ever claimed. The paragraph that covers PTSD due to MST was just the last paragraph of 10 pages of regulations that they sent with the decision. Actual decision starts at the bottom of that page.   Gastone: Did you know anything about the DRO Process Requirement, for the N & M Evidence? I did. My fault I didn't send any. I was fed up with OKC VA and assumed they would send me for a new C&P exam. Stupid on my part.   Gastone: Did you ever get a copy of your 09 PTSD C & P DBQ? No, I did not. Blue button records do not go back that far. I have requested a copy of my C-File. EBenefits states that I will get it between NOV 2017 and NOV 2018.   Gastone:  Do you currently have a VA MH Psychiatrist/Psychologist that treats you on a regular basis? I was being seen at Bohnam, TX VA. After they kept switching Dr's a few times, I now just get my meds re-filled thru my family physician. My husband is active duty, so we are on tri-care prime remote. I also qualify for VA choice, but have not used it.   Gastone: Have they given you an official PTSD DX? I have a PTSD diagnosis and receive 50% SC in 2015.   Berta: Did they have the incident reports? I faxed in two incident reports. They do not show on the evidence list, but stressor was conceded with CAB.   Flores97: Email congressman for C-File. Thank You for the advice. I emailed my congressman today and reiterated the time crunch I am under.     2011 - Appeal decision.pdf 2015 - C&P exam Notes.pdf 2015 - decision part 1.pdf 2015 - decision part 2.pdf 2009 - Rating Sheet.pdf
    • Full Knee Replacement
      I just came back from the Ortho doctor in town he said I need a full knee replacement for my service connected injury after looking at past 11 years of x-rays from the VA and what he just took today. The Marine Corps. somehow don't keep x-rays after a certain period of time. The VA says they will not do one until I'm 60 years old, all they wanted to do was give me injections for the pain. What I have now is a Torn ACL and I'm running bone on bone, and my knee cap is just about gone so here is the question. I already receive 20% for my left knee, due to the past 3 surgery's. So after having the knee replacement what will I be looking at? for an increase? Does the VA have to pay for this since I live 178 miles from the Nearest VA hospital? because they are still telling me if you were injured on active duty you must go to the VA hospital even through the VA says They will not do a knee replacement until I'm 60? I already talked to two Veterans in town at the Vet center and they had the same problem but they paid for it out of their own pocket for the surgery then filed for an increase award. So far they are still waiting for the VA to answer them back. any ideals on the best route to take? I hate to get this done out in a local hospital then fine out the VA will not pay and give me an increase for the full knee replacement. Thank for any information on this subject.

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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

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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

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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.

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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

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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?

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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
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