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Temp 100% Convalescent Pay After A Surgery

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foleyj

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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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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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