Non VA medical bills

[JohnsWidow]

My husband was 100% service connected disabled USMC veteran. He passed away Oct.22, 2016. He had gone to 2 seperate non VA hospitals via ambulance before his passing. The hospitals were aware he was 100% service connected disabled. They have been sending bills for hospital services and he had told their billing departments to send the bills to VISN 16 Consolidated fee unit PO box 320164 Flowood, MS. 39232 several times. Now that he has passed and the same bills are still coming I decided to just enclose a note in all bills stating to remit all bills for payment to the VISN address. They still don't get it. What am I doing wrong? Can anyone suggest a better alternative? Thank you for your time.

Edited January 2, 2017 by JohnsWidow

[Berta]

Have you contacted the law firm that your father had contacted regarding potential malpractice?

Is there a status?

Have you contacted the private oncologist as to the type of cancer (respiratory?) and whether it metastasized from or to something else...and what type of cancer is the 'something else,' if applicable to AO?

Have you contacted the vet rep your mother said handled the DIC app or something with my concerns as to the two problems the AO death claim might have?

I am sure, based on your mother;s past post that this is the vet rep, and her contact info:

 "Mathews, Tracy Veterans Counselor Texas Veterans Commission Conroe CommunityBased Outpatient Clinic 800 Riverwood Court, Suite 100 Conroe 77304- 2824 936/522-4024 936/522-4020 8:00-4:00 Houston"

https://texaswideopenforbusiness.com/sites/default/files/08/21/14/tvc_directory.pdf

[SonOfJohn]

The TVC rep said it doesn't look like there should be any problems with the claim.

I told the Private Oncologist my concern about it being respiratory lung cancer and he said My father HAD to have that in order to be considered for the trail they were running. In my father's last weeks, the cancer spread FROM the lungs to other areas, but it originated in the lungs. (I believe right upper lobe if i remember correctly)

[Berta]

Great! That is good info. That just leaves the 30 year rule to be considered.

You might need to get that in writing from the oncologist but it should definitely be described well in the private medical records, as to the "respiratory" factor of cancer.

I would be negligent if I did not raise potential landmines that I often see in initial claims.I have been a volunteer claims advocate for over 30 years.We learn to think like the VA thinks and can spot potential reasons for denial.

The TVC vet rep is fully versed in 38 USC 1151 and can handle that claim.

TVC might even have their own template for it and if not I posted many 1151 templates here as I have had many 1151 claims ( all awarded.) due to the wrongful death of my husband due solely to his VA medical care.

Someone here said there is a VA form now for 1151 claims but I have found no link to that form.

 

 

 

 

 

[SonOfJohn]

Spoke to TVC and the Veteran's Advocate today at the VA  office. Found out a few things:

1) Apparently the death pension and DIC are mutually exclusive. (I though my mother would be able to receive both)

2) The AO lung cancer claim will ONLY back date as far as the date the claim was made. (in my father's case, this is just one month) I believe that since the VA did not disclose his cancer to him (he was informed by a private physician) it could be legally argued that the first time cancer appeared in his VA medical records would be the first time he WOULD HAVE filed for AO Cancer benefits and that the paid benefits should be back-dated to that time.

In addition, My father has been applying for AO benefits since leaving the service related to skin conditions. These claims were denied. I'm not sure if/how this plays into the equation if at all.

3) TVC advised 1151 form claim (for denial of cancer treatment by VA AND in community care) would be best handled by an attorney. The biggest anticipated argument is that the VA would claim that when discovered, the Cancer was already too-far to be treated. However, since my father was under intense medical observation as a result of his heart operation in Sept 2015, it is unrealistic that cancer IN THAT AREA that was too severe to be treated would have gone unnoticed.

I am still unsure if there is a way to claim AO benefits separate from DIC. I would think this would be easier to argue once the AO/Lung cancer claim is approved and paid. 

 

The VA Advocate advise sending the Non-VA bills to a specific address (I believe in Mississippi) My mother has this address.

[Berta]

"1) Apparently the death pension and DIC are mutually exclusive. (I though my mother would be able to receive both)" 

They can only award one benefit. If your mother is eligible for the pension, but suceeds in the DIC claim, they will pay her the DIC at that point, as it is the greater benefit.

"2) The AO lung cancer claim will ONLY back date as far as the date the claim was made. (in my father's case, this is just one month) I believe that since the VA did not disclose his cancer to him (he was informed by a private physician) it could be legally argued that the first time cancer appeared in his VA medical records would be the first time he WOULD HAVE filed for AO Cancer benefits and that the paid benefits should be back-dated to that time."

They will pay only back to the date of the claim.

"In addition, My father has been applying for AO benefits since leaving the service related to skin conditions. These claims were denied. I'm not sure if/how this plays into the equation if at all."

I dont think it will have any impact at all.(unless the Ao DIC claim is awarded...as explained below re: Nehmer)

"3) TVC advised 1151 form claim (for denial of cancer treatment by VA AND in community care) would be best handled by an attorney. The biggest anticipated argument is that the VA would claim that when discovered, the Cancer was already too-far to be treated. However, since my father was under intense medical observation as a result of his heart operation in Sept 2015, it is unrealistic that cancer IN THAT AREA that was too severe to be treated would have gone unnoticed."

TVC has handled widow's 1151 death claims.

This is one granted at the BVA:

REPRESENTATION

Appellant represented by:	Texas Veterans Commission

ORDER

 

 

Entitlement to Dependency and Indemnity compensation for the

veteran's death under the provisions of 38 U.S.C.A. § 1151 is

granted.

 

https://www.va.gov/vetapp05/Files1/0504208.txt

"I am still unsure if there is a way to claim AO benefits separate from DIC. I would think this would be easier to argue once the AO/Lung cancer claim is approved and paid. "

As far as I know your mother never filed for accrued benefits within one year after the veteran died, and that he had no claims pending at death regarding AO.

If the claim is awarded, and he did have NSC lung cancer listed on any prior VA decision, then the Nehmer Court Order would kick in for more retro  but I did not get the impression that any lung cancer disability was listed was listed on any of his past decision.Under Nehmer Accrued benefits are except from any specific filing date.

There is plenty of info here in our AO forum and I am sure there are templates there from me,as I have filed many 1151s, to include 1151 DIC.

These claims rest on documented evidence of VA negligence/malpractice.

The BVA case above reveals the widow had no independent medical opinion but she and her daughter proved step by step how the VA caused the veteran's death.

I had no IMO either for my 1151 and FTCA case  but I assure you it took a lot of work.

If TVC wont file the claim,you can file it yourself for your mom. Use the templates in the 1151 forum and state specifics from the veteran's medical records, and meantime, seek an independent doctor's opinion opinion based on the complete medical records, VA and non VA, preferably an oncologist.

IMos an be costly and I have no idea if the IMO would reveal malpractice. But in that case, you and your mom would have peace of mind,if a real doctor stated there had been no malpractice at all.

It would be a claim under Section 1151, 38 USC for DIC....separate from the direct SC AO death claim.

You could also contact some lawyers at that point but I completely disagree with this,if this is what TVC said:

"The biggest anticipated argument is that the VA would claim that when discovered, the Cancer was already too-far to be treated."

In 1992 VA doctors ( Syracuse VAMC) realized that in 1988 a local VAMC had not followed up care for a heart attack my husband had while employed at the same VAMC.His heart disease ( ECHO results) by then was almost too far gone to be treated, but they could have began treatments anyhow -to prevent another heart attack----

because the purpose of the VA is to provide medical care.These doctors chose to cover the prior malpractice but that didn't work.

"However, since my father was under intense medical observation as a result of his heart operation in Sept 2015, it is unrealistic that cancer IN THAT AREA that was too severe to be treated would have gone unnoticed. "

That is a very good point to make in the Section 1151 claim.

I will find a 1151 template and post it here for you.

But maybe the TVC 's concern is that this might have involved non VA care as well as VA care...and the 1151 claim has to be based solely on VA medical care and those VA records.

An attorney would want to any private records however, as well.

 

Edited February 2, 2017 by Berta

[Berta]

You can use this template to get the claim into the system

 name address                                                                                                                  Date:

to VARO etc                                                                                               C file #

This is a claim filed under auspices of Section 1151,38 USC for DIC due to the wrongful death of my husband ( full name of deceased)

I believe his VA medical records will reveal that he did not receive a standard of VA medical care comparable with that of the standard and usual medical community, regarding proper and timely diagnosis and appropriate  treatment  of his lung cancer which ultimately caused his death ( date of death here)

I have listed and enclosed copies of  the following records to support this claim:

Death Certificate

Autopsy ( if one was done)

                                                                                     Signed

(your mother must sign this)  

                                                                                   Surviving spouse of (name of deceased)

I think you need to send this to the VA intake center…someone will give you their address.

Get a USPS tracking slip as proof of mailing.

This is basically the same 1151 claim I wrote for a friend of mine years ago.

He had been treated for hemmoroids at local VAMC for years and sent to a different VAMC and came back with a colostomy bag.

They had misdiagnosed colon cancer at the local VAMC. He was awarded 100% P & T under 1151.It went very fast because it was obvious malpractice. 

You will need to provide evidence of the claim so best to get those medical records ASAP.

This will get the claim into the system...and give you time to find a IMO doctor and a lawyer.