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How to Get your VA C-File


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    • My husband died in motorcycle accident
      I got the call from the lawyer's office today. They said they think I have a good case and they officially offered me representation. His fee is 33% if I win the appeal. Is 33% about what every lawyer charges? I also received all of my husband's medical records from Ft. Jackson where he was found non deployable. I also Dr. Valette an email as well.
    • Guidance request on C&P exam - PTSD, hearing loss, and tinnitus
      rvance313: The best advice I was given is to learn as much about the VA disability process as possible so you can go thru this and other Veteran Forums for the similar contentions that you may have? Learn about Range of Motion (ROM) and how pain factors into your CP Exams and what you should do during those exams. I also learned to ensure that you are very clear at what you are claiming from the start and this may eliminate a lot of heartburn down stream in the process. For instance, as I was inexperienced, a VSO helped me with listing my initial contentions which was a mistake for me. For instance, I have bad "prostatitis" for many years and it was clearly within my service medical records. However, she listed it as "groin pain" as a contention that was later denied. Mainly, because it was not listed very specific and a specific diagnosis code, it was denied -I believe for that reason? When I said to her, "I read that contentions need to be very specific" and she said, "Don't worry, the VBA Rater will figure this all out for you anyway"--infamous last words?  As a result, I learned not to rely so much on a VSO who may or may not know their jobs well? Also, you have to make it as easy as possible for the VBA  rater to rate your claims by providing the best evidence and injury linkage to your service  that you can in the form of medical records, & showing a continuing chronic condition. Also, if your medical records are incomplete, then you should get buddy statements from  those that were there when you were injured. Also, try to review the VA DBQ Questionnaires, that correspond to your Contentions - &  CP Exams that they are going review for your case and claim. That way you get a sense of the questions that the CP doctor is going to ask so you have an idea beforehand of how to respond. Many Vets get nervous the first time they have a CP exam and don't always respond with the information that is in their heads? Most of the information can be found in the hadit.com & ASKNOD forums and from people like Berta & Asknod (among many others) (whom are all amazing for advice). Granted, the VA Disability process is very complex and many Vets have negative experience along the way. But if you can read, the average person can figure a lot of it themselves. But even with negatively, you can't let it sour you or put you into a defensive position to just give up? Many do and blame others for their misfortune with their claims outcomes? But I feel you (Vets) only lose when you (they) give up and I'm glad you came back. I honesty get the complaints because I've had CP exams that I felt betrayed by the doctor and staff leaving things off of the final exam that hurt my ratings and resulted in a lower rating. For instance, I have heart issues and was granted  only 10% for Hypertensive Heart Disease after a long battle. But, it would have been rated 20% if they had listed my complaints about my chest pains and the use of nitro for my angina? Those issues are listed all over my service medical records and I put it on the pre-exam forms that I was sent. But it was ignored? Anyway, I tell Vets that in many cases it's just the "Luck of the Draw" whom does your CP exams but it has a big impact of what they list. Also, you are very right about honesty because it's the best policy for everything in life -not just VA claims. But, just like going into battle, the better trained and prepared that you are, the better the outcome of your claims will be. Also, if you hit an obstacle, have a plan B & C, but learn, learn and learn all you can about the VA Disability process from forums like Hadit.com so that when they throw you a curve ball on a claim, you'll know how to react. As a matter of fact, I'm working on my first Notice of Disagreement or NOD and I'm applying everything that I just spoke about in this post. Anyway, I wish you Good Luck and Godspeed- Rootbeer22 
    • Aortic valve /ihd
      I would send in any more evidence you have but I still recommend getting an Independent Medical Opinion. "His vso said it could take another 4.5 yrs.. That is a nine yr wait all together. " I dont understand the 9 year math here. I assume the NOD was filed in time. The rating criteria for DMII is here in our VA Schedule of Ratings forum. His medical evidence must warrant a rating higher than the 20%. If the "aid 8.1 " was his actual HBIAC ,that should help. Personally I don't think any Congressman could help with this ,at this point, as it is a medical issue, that a strong IMO/IME could help resolve. But others will chime in on that.
    • eBenefit Letters Down?
      Tried 2 different computers, firefox, safari, internet exploder.... no change
    • GAD & Depression C&P results, any advice?
      Hi all- moved to "pending decision approval" this morning...
      and I'm freaking out. Hopefully it gets approved. My biggest fear right now is having them not SC this even though the c&p agreed and put in favor of service connection. Or them saying they need more info for some random reason.. The wait is almost over, I will keep all updated. Hope everyone is doing well!!   -Shelby
    • Knee Condition
      Thank you, I've contacted Ortho and requested a call back from him. I appreciate the information.
    • Aortic valve /ihd
      Berta,. He has a rating for 20% now.  And by the way that was did in Mountain home ar.  They opened a small va clinic there and they are the ones that diagnosised it and even put the claim in for him.  We totally surprised that they did that.    Do we have to wait to send anything in, since it is showing in intake center, or should we go ahead and send in?  His vso said it could take another 4.5 yrs.. That is a nine yr wait all together.  Should we contact our congressman?  Just frustrating. 
    • Guidance request on C&P exam - PTSD, hearing loss, and tinnitus
      OIF vet here.  Like many, I currently struggle with the daily affects of past war zone experiences.  I initially submitted a claim back in 2010 but was denied.  Frustrated, I gave up on it and chose to deal with my struggles on my own.  Following advice I was given, last year (March 2015), I submitted an intent to file a new claim.  I have been following ebenefits to make sure if the ball is dropped, it is not on my end.  Recently, my claim was moved from the "gathering of evidence" phase to the "preparation for decision" phase and about a week later was changed back to "gathering of evidence".  None of this concerns me, as I know the process takes some time but from what I understand, I should be expecting something in the mail soon informing me of dates for my C&P exam(s).  This leads to my purpose for writing this; I have heard/read horror stories about how vets seemingly have been totally screwed out of the compensation and help they deserve due to the ridiculous results from their C&P exam.  I am simply trying to have my proverbial "T's" crossed and "I's" dotted when my exam date comes and also help all other vets that may be worrying about this same issue.  What I mean by this is, I would like to know if there are things that I should avoid saying/doing or is there anything that anyone has thought hindered their ability to get the desired results from their exam, etc.  Under no circumstances will I lie about my experiences or my conditions but I would like to ensure I do not screw myself using improper wording or something of that sort (as I have seen the VA has done to many vets).  

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foleyj

Temp 100% Convalescent Pay After A Surgery

22 posts in this topic

I submitted a claim for convalescent pay after spine surgery and the doctor put that I would be out for 3 months. I just received that payment, but it is a lower amount then I was told. I am rated at 60% with a spouse and one child. The 100% rate would be 2932.00. If I am doing the math correctly 2932.00-1129.00=1803.00. The difference is 1803.00 and that should be the amount that I should have gotten for the 3 months for a total of 5409.00. The payment that I received was 4335.00. Is this the way the VA calculates this, or is there a different rate table for this type of situation?

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It should be t he 100 percent rate minus your current amount times 3.

You may be correct, Call them up and ask them to re figure it.

J

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Thats what I thought. Thanks.

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I get the 60% vet with 1 wife, 1 child at 1129 per month -

100% vet,wife ,child 2932 per month

2932 less 1129 (what they should have paid you for those 3 months already-as your regular 60%) = 1803.

1803 times 3 months is 5409-

YES I think you are correct too-the difference soesnt make sense

I have had some errors on VA checks in the past-some a few hundred bucks and one was almost 40 thousand bucks.

If I were you I would write to them ASAP and state to them (keep copy, send priority or certified)that they have made a clearly erroneous mathematical error to your detriment in their decision or award letter dated xx xx xxxx and I always send them my calculations.Best to do that too.

They have always responded fairly swiftly and sent the cash soon too.

Except for my most recent ordeal and I went way over their heads on it.

They can fix this easily in your case . It shouldn't take long.

(Then again-Chapter 35 had started to refund my tuition-and sent me a check sometime ago and also the form AMU needed to fill out for audit of my additional tuition. A simple task. Yesterday I learned from AMU that VA has only recently released proof of my eligibility for this-the award letter is dated April 29th,and there are 2 more award letters as well.

They (VA) apparently stopped the Chapter 35 VA people from properly processing my award.

They also have held up my REPS for months.

I asked the school to state to me exactly what VA did with my VA forms.

Perhaps this was in fact an error at AMU finance office.

But I am collecting documentations on all this in case I have opportunity to give testimony again to the H VAC.

If they are treating me,as widow of a vet who died due to direct service connection,this arbitrary and capricious way- how the heck are they treating the widows and widowers of OIF OEF veterans who died in service?)

You have a simple error they should be able to fix right away.

Maybe. I have waited 9 months for them to fix a major and obvious retro error in my award.Still waiting.

Edited by Berta

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If you were house bound after your spine surgery, you can file for that, I got it for 3 months and it was 3123 dollars I think, I know it was over 3100 dollars, you might want to check in to that.

Ken

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Well I finally got in touch with a very helpful VA rep on the phone. I was actually surprised that this person was so helpful, but anyway here is the response that was sent to me. Now keep in mind that the original claim was for 3 months.

Mr. Foley:

This is in response to your inquiry dated January 29, 2010, regarding retroactive pay.

Based on the notification letter, the VA granted temporary 100% for two months, September 2009 and October 2009. September 1, 2009 - October 31, 2009 $3,756.00 for temporary 100% with 2 dependents.

I am trying to figure out why I was only paid for two months instead of three. The letter that I sent in from the doctor clearly states that the convalescence will be 3 months.

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I suggest you ask them to CUE themselves on their financial error-tell them why the amount is wrong and send them copy of the doctor's statement.

It seems the response you got only confounded the issue more.

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I had the exact same situation post spinal surgery. You must remember that the date of the operation is not the date you are paid from. If you had the operation on Jan. 3rd (as I did last year) you will get nothing for Jan. as you weren't 100% for the entire month and VA does not pro-rate.

So if the 3 months of total disability doesn't begin on a 1st of the month and go to the last day of the 3rd month you will get bumped down to only two months pay. That is what I was given.

I had surgery on Jan 3rd and was off work until June 15th. I requested 4 months of temp 100% due to Jan. and June not being complete months. I received 2 months due to my claim being awarded in March. I have on appeal a request for the other 2 of the 4 months and should win. My claim is supposedly at the final rater and is awaiting authorization.

Hope that makes sense.

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Thanks for the info it does somewhat clear things up. The only problem with my situation is that the surgery was on 7/8/2009, so if the VA starts the rating on the 1st of the next month shouldn't it have started on the 1st of August? The other problem is that this is not mentioned anywhere in the regulation that explains the rating criteria. So would it help if I went back to my doctor and had him amend the order for my convalescence? I was actually off of work until November, I just read the regulation and told him to make it 3 months and he said if I needed more to just tell him.

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I just the regulation for this and this is what I found;

A total disability rating (100 percent) will be assigned without

regard to other provisions of the rating schedule when it is established

by report at hospital discharge (regular discharge or release to non-bed

care) or outpatient release that entitlement is warranted under

paragraph (a) (1), (2) or (3) of this section effective the date of

hospital admission or outpatient treatment and continuing for a period

of 1, 2, or 3 months from the first day of the month following such

hospital discharge or outpatient release.

So I see where it says from the first day of the month, but it also says that the effective date is the date of admission or treatment. So this is confusing. If the effective date is the date of admission, than why isn't paid from this date? This is the date at which you become 100%.

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I think Quint is right on this. Maybe someone can look it up, but I remember reading something about benefits starting the first day of the month following your application. So if you apply july 14, then it does not start until August.1.

Using this example, you may even get more money next month. In other words, you get 2 months of retro, and one month of "regular" 100%, so it would come out in the wash.

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Yes that what I would think that it would start August 1st, but in the award letter it states it is from September 1, 2009 - October 31, 2009 $3,756.00 for temporary 100% with 2 dependents. I am just wondering why it didnt start august first.

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I just the regulation for this and this is what I found;

A total disability rating (100 percent) will be assigned without

regard to other provisions of the rating schedule when it is established

by report at hospital discharge (regular discharge or release to non-bed

care) or outpatient release that entitlement is warranted under

paragraph (a) (1), (2) or (3) of this section effective the date of

hospital admission or outpatient treatment and continuing for a period

of 1, 2, or 3 months from the first day of the month following such

hospital discharge or outpatient release.

So I see where it says from the first day of the month, but it also says that the effective date is the date of admission or treatment. So this is confusing. If the effective date is the date of admission, than why isn't paid from this date? This is the date at which you become 100%.

The VA doesn't pro-rate so no matter what date the surgery was you get paid from the 1st of the month after the operation. As far as benefits you would be eligable from the date of the operation. Also to have a Dr. Write that you are off for 3 months might not be enough for the VA. They might want proof that you were out of work for 3 months. I was told that VA won't preapprove temp 100% because you haven't been disabled for that time (meaning you 'might') go back to work before the total time that you requested 100% for. i.e. we won't pay until you were already disabled.

This is just my experiance and hopefully others will chime in.

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The VA doesn't pro-rate so no matter what date the surgery was you get paid from the 1st of the month after the operation. As far as benefits you would be eligable from the date of the operation. Also to have a Dr. Write that you are off for 3 months might not be enough for the VA. They might want proof that you were out of work for 3 months. I was told that VA won't preapprove temp 100% because you haven't been disabled for that time (meaning you 'might') go back to work before the total time that you requested 100% for. i.e. we won't pay until you were already disabled.

This is just my experiance and hopefully others will chime in.

Quint thanks for the info. After more digging it seems that instead of the effective date of the claim being the day I had surgery, which was 7/8/2009, the VA applied the effective date that they received the claim which was 8/6/2009. Now I guess I have to go back and submitted an NOD and explain everything all over again.

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Foleyj: Any update? I have a similar situation, and I'm wondering if you had any success. I was supposed to get 3 month temp 100% for heart surgery. My surgery was 7/2/09; the VA rec'd my claim on 8/3/09; the effective date of my temp 100% is 1 Sep 09, ending 1 Nov 09. 2 months instead of 3. I understand that they don't prorate - so I'm wondering why it wouldn't be 1 Sep 09 thru 1 Dec 09 for the temp 100%.

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Foleyj: Any update? I have a similar situation, and I'm wondering if you had any success. I was supposed to get 3 month temp 100% for heart surgery. My surgery was 7/2/09; the VA rec'd my claim on 8/3/09; the effective date of my temp 100% is 1 Sep 09, ending 1 Nov 09. 2 months instead of 3. I understand that they don't prorate - so I'm wondering why it wouldn't be 1 Sep 09 thru 1 Dec 09 for the temp 100%.

Hi,

No I haven't heard anything yet. I contacted the VA office and spoke with the VA rep that is also my POA and she sent an email to someone she said would take care of it. I have emailed her and have not heard back from her. You might want to contact someone about this because I think that the VA is not rating this correctly. If you go back and look at § 4.30 Convalescent ratings you will see that it states A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. My surgery was 7/8/09 and I was released on 7/12/09. I sent the claim in and it was received on 8/6/09. So they made 8/6/09 my effective date and then began the 100% rating on Sept 1st. I sent messages to them through IRIS and the response that I got was that the VA only takes the advice of the doctors for the period of convalescence and they can determine what they think is an adequate convalescence. This is crap because if the doctors note says that you get 3 months then that is what you get. I would definitely contact your VSO or the VA office in your state. I will post something when I get an answer.

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Good luck to you. What I don't understand in my situation is that the schedule of ratings for heart bypass surgery specifically states:

7017 Coronary bypass surgery:

For three months following hospital admission for surgery.......................................... 100

Seemed like a no-brainer to me, but I guess I was wrong.

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Good luck to you. What I don't understand in my situation is that the schedule of ratings for heart bypass surgery specifically states:

7017 Coronary bypass surgery:

For three months following hospital admission for surgery.......................................... 100

Seemed like a no-brainer to me, but I guess I was wrong.

Yeah you would think so. I have a feeling that they just automatically just give 2 months and then hope that you just get frustrated and forget about it. I can't seem to find anyone that actually understands the rating schedule. Good luck with yours.

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What was the outcome?

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Still waiting since 3/11 when I filed for a scope knee surgery and missed one month of work.Sent in with all evidence and no movement since then.

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I am currently rated @ 0% and have been since I first received my rating in 1994. I have tried to appeal the rating the same year but lost interest due to deciding to try and work and raise my son. In 2013 I was told that I would have to get knee surgey and again restarted my claim to increase my rating. I did have the surgery in Dec 2013 and was surprised that I received a check for  my time that I was out of work which I was suppose to be out for 4 months but went back early due to a good job opportunity. It is now 2016 and I again have to get surgery on the same knee and since I already know I will get 100% while I am convalescing I was wondering if it gets paid monthly or is it paid at the end of the period I will be out. Since I do not receive any monetary amount due to my 0% rating would I receive the full amount for the time I am out of work as stated by my doctor.  

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21 minutes ago, Gayren67 said:

I am currently rated @ 0% and have been since I first received my rating in 1994. I have tried to appeal the rating the same year but lost interest due to deciding to try and work and raise my son. In 2013 I was told that I would have to get knee surgey and again restarted my claim to increase my rating. I did have the surgery in Dec 2013 and was surprised that I received a check for  my time that I was out of work which I was suppose to be out for 4 months but went back early due to a good job opportunity. It is now 2016 and I again have to get surgery on the same knee and since I already know I will get 100% while I am convalescing I was wondering if it gets paid monthly or is it paid at the end of the period I will be out. Since I do not receive any monetary amount due to my 0% rating would I receive the full amount for the time I am out of work as stated by my doctor.  

Gayren67;

You might want to start a new thread - this one is over 5 years old....

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