tdiu Fully Developed Claim Question

[derenick52]

Hey All,Am currently rated at 90% COMBINED With 100% UNEMPLOYABILITY Since 2001,my right hip is 20%-Had my hip replaced in June,called the Disabled American Veterans Service officer in May-to file for Surgery convalescence rating for 13 months-which will take the 20% TO 100% and then to a minimum of 30% After 13 months-she said she is sending me the FULLY DEVELOPED CLAIM form and it should take a couple of months to process,and to submit my Surgery report,Did this about a week after surgery,obtained a E Benefit password in August and was listed as a Traditional claim,the DAV told me there was a error in processing,contacted my Senators office to check into the situation-SEE FIRST Attachment from Va and Second attachment from Senators office,this Claim would take me to AID AND ATTENDANCE-100% plus a additional 60%,For which I Qualify,then last week received a letter from Regional office- claim is delayed again,contacted the DAV as to what is happening-their response-SEE 3RD Attachment,The Va is now saying I am NOT eligible for FDC Claim Process since I am already receiving 100% Rate-?? I read the FDC Rules-says it can be used for surgery convalescence and Aid and attendance claims-?? Anybody had any experience with a claim like this-? THANKS For any advice,Happy New year

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Edited April 30, 2014 by derenick52

[meghp0405]

you don't meet the requirement for the convalescence special monthly allowance. You are already receiving pay at the 100% rate. I think you have misunderstood someone.

this special monthly compensation is for veterans that are rated less than 100%. If you have surgery and the convalescence is 21 days or longer, the veteran is entitled to receive the special monthly compensation for the duration of the convalescence. Example, lets say your overall rating is 60%, you have surgery on your SC disability of right hip, the convalescence is 90 days, the VA will pay you the difference between the 60 and 100 %.for 90 days. Since you are already receiving 100%, you don't qualify The VA does not pay more than 100% for a disability unless you fall into one of the categories listed in 38 CFR, chapter 1114.

You are not entitled to aid/attendance because your not at the 100% plus 60%. SMC's are not determinations for A/A simply because it is not a permanent rating.

I have submitted many FDC's for the special monthly compensation and never had any issues.

Research 38 CFR, chapter 1114, this chapter covers all the special monthly compensation codes

Once your convalescence period is over, the VA will bring you back in for a C/P exam to re-evaluate your hip. You have to remember, surgeries are supposed to correct or fix the problem. Sometimes that works and there are other times that it doesn't. Also, your % on you hip will be determined upon your range of motion. You can have 10 surgeries on a joint, but it is the ROM that determines the %. When they bring you back in for a re-evaluation, I'm sure the doc will request an x-ray. Almost always, arthritis will appear and with the medical documentation and a diagnosis, you can submit a claim for arthritis.

Edited January 1, 2014 by meghp0405

[carlie]

Hey All,Am currently rated at 90% COMBINED With 100% UNEMPLOYABILITY Since 2001,my right hip is 20%-Had my hip replaced in June,called the Disabled American Veterans Service officer in May-to file for Surgery convalescence rating for 13 months-which will take the 20% TO 100% and then to a minimum of 30% After 13 months-she said she is sending me the FULLY DEVELOPED CLAIM form and it should take a couple of months to process,and to submit my Surgery report,Did this about a week after surgery,obtained a E Benefit password in August and was listed as a Traditional claim,the DAV told me there was a error in processing,contacted my Senators office to check into the situation-SEE FIRST Attachment from Va and Second attachment from Senators office,this Claim would take me to AID AND ATTENDANCE-100% plus a additional 60%,For which I Qualify,then last week received a letter from Regional office- claim is delayed again,contacted the DAV as to what is happening-their response-SEE 3RD Attachment,The Va is now saying I am NOT eligible for FDC Claim Process since I am already receiving 100% Rate-?? I read the FDC Rules-says it can be used for surgery convalescence and Aid and attendance claims-?? Anybody had any experience with a claim like this-? THANKS For any advice,Happy New year

Scan 1 has your claim # on it.

Please edit out the personal info like that & addresses.

Thanks

[derenick52]

Hey,thanks for the input meghp0405,the Dav service officer said this was a Good claim,what is the deal with Rating code 5054-Hip replacement-this is what I filed the claim under,100% For 13 months,then a minimum of 30%,I specifically asked her in September if this was a Valid claim,as I would not pursue it if not,I had back surgery in the early 80's and the procedure you explained above is how it went,Carlie-I guess I should DELETE Those letters and white out name and repost-? THANKS For the help

[Loose Cannon]

You should delete that quick. I noticed it too!

LC

[Loose Cannon]

Delete Scan # 1 & 2... BOTH have it on there!

[Loose Cannon]

Also,

Not to throw fuel to the fire already raging but...Shouldn't your VSO have known the info regarding submission of FDC Claims rules/regs PRIOR to their actions on your behalf???!!! Scan of doc from DAV speaks for itself...

Be wary of this organization as many vets(even on this site) including me, have had nothing positive to say about them...JMHO.

LC

Edited January 2, 2014 by Loose Cannon