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Inferred Claims/effective Dates

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Inferred claims/effective dates

This might be a bit wierd...

Regarding inferred claims and effective dates, I understand that if you seek medical treatment within 12 months of your claim request, then the EED is the date when treatment was sought.

Given this hypothetical situation, what would be the effective date?

Jul 2007 - Office visit, condition diagnosed, prescribed monthly medication to treat condition

{insert 3-4 VA telenurse refill calls}

Aug 2009 - Office visit for condition

Oct 2009 - Filed claim for condition

The medication refills were requested every month and renewed via VA nurse line as needed.

Would the effective date be Jul 2009, Aug 2009, a VA telenurse refill call between Oct 2008 and Jul 2009, or by oldest date where refills were received?

I'm curious if the VA defines the inferred date based on an office visit, telenurse refill calls, or merely because the Vet was receiving medication for the condition (i.e. receiving treatment).

Thanks

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Inferred claims/effective dates

This might be a bit wierd...

Regarding inferred claims and effective dates, I understand that if you seek medical treatment within 12 months of your claim request, then the EED is the date when treatment was sought.

Given this hypothetical situation, what would be the effective date?

Jul 2007 - Office visit, condition diagnosed, prescribed monthly medication to treat condition

{insert 3-4 VA telenurse refill calls}

Aug 2009 - Office visit for condition

Oct 2009 - Filed claim for condition

The medication refills were requested every month and renewed via VA nurse line as needed.

Would the effective date be Jul 2009, Aug 2009, a VA telenurse refill call between Oct 2008 and Jul 2009, or by oldest date where refills were received?

I'm curious if the VA defines the inferred date based on an office visit, telenurse refill calls, or merely because the Vet was receiving medication for the condition (i.e. receiving treatment).

Thanks

When I received the award of my ED on my neck claim of 2 years the radiculopathy was dated to the date it was diagnosed by neurology. However, I had documentation placing the first reports as 2-3 months earlier. I have requested an EED back to the date of first documented complaint.

Bergie

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It should be October 2009, cuz that's when you filed the claim. You should have filed when you were first diagnosed.

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Inferred claims/effective dates

This might be a bit wierd...

Regarding inferred claims and effective dates, I understand that if you seek medical treatment within 12 months of your claim request, then the EED is the date when treatment was sought.

Given this hypothetical situation, what would be the effective date?

Jul 2007 - Office visit, condition diagnosed, prescribed monthly medication to treat condition

{insert 3-4 VA telenurse refill calls}

Aug 2009 - Office visit for condition

Oct 2009 - Filed claim for condition

The medication refills were requested every month and renewed via VA nurse line as needed.

Would the effective date be Jul 2009, Aug 2009, a VA telenurse refill call between Oct 2008 and Jul 2009, or by oldest date where refills were received?

I'm curious if the VA defines the inferred date based on an office visit, telenurse refill calls, or merely because the Vet was receiving medication for the condition (i.e. receiving treatment).

Thanks

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What is the regulation that says your effective date for a claim is the first time you saw a doctor for it? I had not heard that before.

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Sorry, I forgot to note that this is for an increase request, not an initial rating.

§3.400 (o)(2), see below:

(o) Increases (38 U.S.C. 5110(a) and 5110(:D(2), Pub. L. 94-71, 89 Stat. 395; §§3.109, 3.156, 3.157):

(1) General. Except as provided in paragraph (o)(2) of this section and §3.401(:o, date of receipt of claim or date entitlement arose, whichever is later. A retroactive increase or additional benefit will not be awarded after basic entitlement has been terminated, such as by severance of service connection.

(2) Disability compensation. Earliest date as of which it is factually ascertainable that an increase in disability had occurred if claim is received within 1 year from such date otherwise, date of receipt of claim.

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John

The regulation you mentioned refers to an increase, as follows:

3.157 Report of examination or hospitalization as claim for increase or to reopen.

(a) General. Effective date of pension or compensation benefits, if otherwise in order, will be the date of receipt of a claim or the date when entitlement arose, whichever is the later. A report of examination or hospitalization which meets the requirements of this section will be accepted as an informal claim for benefits under an existing law or for benefits under a liberalizing law or Department of Veterans Affairs issue, if the report relates to a disability which may establish entitlement. Acceptance of a report of examination or treatment as a claim for increase or to reopen is subject to the requirements of §3.114 with respect to action on Department of Veterans Affairs initiative or at the request of the claimant and the payment of retroactive benefits from the date of the report or for a period of 1 year prior to the date of receipt of the report.

(Authority: 38 U.S.C. 5110(a))

(;) Claim. Once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of one of the following will be accepted as an informal claim for increased benefits or an informal claim to reopen. In addition, receipt of one of the following will be accepted as an informal claim in the case of a retired member of a uniformed service whose formal claim for pension or compensation has been disallowed because of receipt of retirement pay. The evidence listed will also be accepted as an informal claim for pension previously denied for the reason the disability was not permanently and totally disabling.

(1) Report of examination or hospitalization by Department of Veterans Affairs or uniformed services. The date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim. The date of a uniformed service examination which is the basis for granting severance pay to a former member of the Armed Forces on the temporary disability retired list will be accepted as the date of receipt of claim. The date of admission to a non-VA hospital where a veteran was maintained at VA expense will be accepted as the date of receipt of a claim, if VA maintenance was previously authorized; but if VA maintenance was authorized subsequent to admission, the date VA received notice of admission will be accepted. The provisions of this paragraph apply only when such reports relate to examination or treatment of a disability for which service-connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission.

(Authority: 38 U.S.C. 501)

(2) Evidence from a private physician or layman. The date of receipt of such evidence will be accepted when the evidence furnished by or in behalf of the claimant is within the competence of the physician or lay person and shows the reasonable probability of entitlement to benefits.

(3) State and other institutions. When submitted by or on behalf of the veteran and entitlement is shown, date of receipt by the Department of Veterans Affairs of examination reports, clinical records, and transcripts of records will be accepted as the date of receipt of a claim if received from State, county, municipal, recognized private institutions, or other Government hospitals (except those described in paragraph (:D(1) of this section). These records must be authenticated by an appropriate official of the institution. Benefits will be granted if the records are adequate for rating purposes; otherwise findings will be verified by official examination. Reports received from private institutions not listed by the American Hospital Association must be certified by the Chief Medical Officer of the Department of Veterans Affairs or physician designee.

Edited by broncovet

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