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  1. Today
  2. VA screwed up as usual, I got a knee replaced and the VA is only giving a temp 100% for 2.5 months then down to 10%. I have an appointment with a VA rep Monday, I wonder how long it will take to straighten this out.
  3. I received the results. Only a 10% increase from 60% to 70% for left and right knee, all other claims were denied. I need a good appeals lawyer. Anybody know any?
  4. Yesterday
  5. Seaman 6 "Posted March 4 Hello, new here. Working through getting an increase on my s/c issues and it has been brought to my attention I should have had my left knee s/c this whole time (medically retired 12 years ago). I have photographs of me competing in triathalons while wearing a knee brace on my left knee while on active duty. Platts data with my matching bib number backs up the dates of the photographs. Is this enough for the VA to service connect or should I still get a nexus letter? I’m s/c for pes planus and right knee, so could definitely get a letter for left knee secondary to those issues, but would prefer to just submit what I have. It seems like a smoking gun, but don’t want to assume how the VA will look at this. Thank you!" If you are not working now and you have or can get a physician's statement that you are not working because the military contributions to your disabilities are the primary reason for your not working, then you should apply for an extra-schedular TDIU. My TDIU was given to me back to the last day of my full-time employment. Also very helpful, which I had in the record at the time I applied for extra-schedular TDIU was a part-time employer's statement about the problems he had to make allowances for to continue me in part-time employment. My part-time employment ended i 1990, My claim was in 1987 before I took the part time job thinking I might be able to keep it up by spending more hours on the job to at least bring some money into my home. My EED was back to 1985, finally granted in 2020 because the AOJ had not processed it. It also helped that there was a Social Security "CAVES" report in my record. SS does a much better investigation and research. If you can get SS to take up your claim for SSDI or SSI you will be ahead because their physicians tell it like it is in their reports. Plus they interview past employers, friends etc. that have witnessed your disabilities in action.
  6. So true, Pacman! Force them to make an official decision. Maybe you could even get an EED for TDIU. If VA knew you were unemployable they should have considered TDIU years ago. When did you file for VA compensation for the first time? Generally, if you don't ask for TDIU or other VA benefits you don't get squat from VA. I can't see how you don't have a good claim for TDIU. I got it back in 2001 and I had been unemployable for about a year.
  7. I actually have two separate memorandums placed in my records. The other memorandum is for Persian Gulf Veteran - See 1117 that states: The Department of the Defense (DoD) has provided VA with authoritative data that verifies the veteran named below meets the definition of a Persian Gulf Veteran as specified by 38 U.S.C. 1117. So, I am a little off and what was the point of my DD 215 listing my special awards that I served during my service? The Military of Records had already verified my service records and acknowledged my special duties and awards.
  8. Since I received 20% for bladder cancer, mine must be in that over 12,000 pages somewhere. I will search the RBA for 38 U.S.C. 1119.
  9. I filed a claim for GWS many years ago and of course my claim was denied. Going through my records today I found a recent internal memorandum from the (OABD) Office of Automated Benefits Delivery with this information. The VA denied my claim and if I had never got a copy of my file I would never know. The Department of Defense (DoD) has provided VA with authoritative data that verifies the veteran named below had military service that constitutes presumptive toxic exposure per 38 U.S.C. 1119. Below list my name and my full SSN.
  10. The following is current as of 03/202 Always check the VA's Page for the latest information. PDF CSP_Eligibility_Criteria_Factsheet.pdf Eligibility Criteria Fact Sheet Veteran Eligibility Requirements: A Veteran or Service member may be eligible for a Family Caregiverif all of the following requirements are met: 1. The individual is either: A Veteran; or An Armed Forces member undergoing a medical discharge from the Armed Forces. 2. The individual has a serious injury (including serious illness) incurred or aggravated in the active military, naval, or air service line of duty. For purposes of PCAFC, serious injury means any service-connected disability that (1) Is rated at 70 percent or more by the VA or (2) Is combined with any other service-connected disability or disabilities, and a combined rating of 70 percent or more is assigned by VA. 3. The individual is in need of in-person personal care services for a maximum of six (6) continuous months based on any one of the following: An inability to perform an activity of daily living; A need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury or There is a need for regular or extensive instruction or supervision, without which the ability of the veteran to function in daily life would be seriously impaired. 4. Participating in the program is in the individual's best interest. 5. Personal care services provided by the family Caregiver will not be simultaneously and regularly provided by or through another individual or entity. 6. The individual receives care at home or will do so if the VA designates a Family Caregiver. 7. The individual receives ongoing care from a Primary Care Team or will do so if the VA designates a family caregiver. Family Caregiver Eligibility Requirements A Family Caregiver must: 1. Be at least 18 years of age. 2. Be either: The eligible Veteran’s spouse, son, daughter, parent, stepfamily member, or extended family member; or Someone who lives with the eligible Veteran full-time or will do so if designated as a Family Caregiver. 3. Be initially assessed by the VA as being able to complete caregiver education and training. 4. Complete caregiver training and demonstrate the ability to carry out specific personal care services, core competencies, and additional care requirements. In addition, there must be no determination by the VA of abuse or neglect of the eligible Veteran by the caregiver. Stipend Levels: The amount of the monthly stipend the Primary Family Caregiver is eligible to receive is determined based on information gathered during the VA’s Evaluation of the Veteran’s personal care needs. Level One: The Primary Family Caregiver’s monthly stipend is calculated by multiplying the monthly stipend rate [Office of Personnel Management (OPM) General Schedule (GS) Annual Rate for grade 4, step 1, based on the locality pay area in which the eligible Veteran resides] divided by 12 multiplied by 0.625. For example, the GS rate at grade 4, step 1, in Dallas, Texas, 2022 was $34,916 annually. Thus, the monthly stipend for a Primary Family Caregiver of an eligible Veteran in Dallas, Texas, at this rate ($34,916, divided by 12 multiplied by 0.625) was approximately $1,818.54 in 2022. Level Two: If the VA determines the eligible Veteran meets the definition of“unable to self-sustain in the community” for the purposes of PCAFC, the designated Primary Family Caregiver’s monthly stipend is calculated by multiplying the monthly stipend rate (OPM GS Annual Rate for grade 4, step1, based on the locality pay area in which the eligible Veteran resides)divided by 12 multiplied by 1.00. For example, the GS rate at grade 4, step 1, in Dallas, Texas, in 2022 was $34,916 annually. The 2022 monthly stipend amount for a Primary Family Caregiver of an eligible Veteran in Dallas, Texas, at this rate($34,916, divided by 12 multiplied by 1.00) was approximately$2,909.67 Definitions Unable to Self-sustain in the Community For purposes of PCAFC, "unable to self-sustain in the community" means that an eligible Veteran either: Requires personal care services each time he or she completes three or more of the seven activities of daily living (ADL) listed in the definition of an inability to perform an activity of daily living in this section and is fully dependent on a caregiver to complete such ADLs; or Has a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury on a continuous basis; or
 There is a need for regular or extensive instruction or supervision, without which the veteran's ability to function in daily life would be seriously impaired on a continuous basis. Inability to Perform Activity of Daily Living (ADL) For purposes of PCAFC, the "inability to perform an ADL" means the Veteran or Service member requires personal care services each time he or she completes one or more of the ADLs listed below. Dressing or undressing oneself Bathing Grooming oneself in order to keep oneself clean and presentable Adjusting any special prosthetic or orthopedic appliance that, by reason of the particular disability, cannot be done without assistance (this does not include the adjustment of appliances that nondisabled persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.) Toileting or attending to toileting Feeding oneself due to loss of coordination of upper extremities, extreme weakness, inability to swallow, or the need for a non-oral means of nutrition
(walking, going upstairs, transferring from bed to chair, etc.) Requiring assistance with an ADL only some of the time does not meet the definition of an "inability to perform an ADL"
  11. Last week
  12. Welcome to hadit. Now, some bad news and good news: First, the bad news: You probably dont understand it. VA compensation is paid "in arrears". Nobody gets paid because they think they will be disabled next month. Instead, you get paid for last month. And, VA "does not pay" a part of a month. Full month or none. Therefore, if your effective date was April xx, then your first check would be the first day of the month FOLLOWING APRIL, (aka May)or the first of June. Dont feel like the lone ranger, most vets get it wrong by a month, for reasons I just posted above. Now, the good news, which could be very good. VA has gotten every one of my effective dates wrong, I appealed them, and eventually won. Shorting you on effective dates is the VA 3 most favorite thing, after delays, and denials. You should carefully review your decision and, you may well need your records at hand, to see if you should have gotten: A. A higher percentage (VA loves to lowball) B. Hornswaggle the effective date. My first question is are you working..if you are not, and it is because of sc conditions, then you should be 100 percent or tdiu. The regulations state the effective date is the later of your claim date, or facts found, (the date the doc said you were disabled). But there are multiple exceptions, and see if one or more of these apply to you: 1. If you applied within a year of your military discharge. you should get an effective date back to date of discharge. 2. If you were seeking an increase. 3. If you submitted new evidence. 4. If there was a change in regulations, such as AMA, pact act, etc. 5. If you are Nehmer class, or Pact Act. 6. If va committed clear, unmistakable error that was "outcome determinative". (There are probably others, but, heck, maybe Im in a senior moment)
  13. I had cervical spinal surgery in April of 2020 and was awarded 100% temporarily for April and May of 2020. I was also awarded 60% for August. They never paid me the 100% for April. How do I go about getting the pay they said I was awarded for the month of April? They paid me for May and August.
  14. AMA is the same as HLR. And so the RO and DRO decisions get repeated. Unless the HLR is initiated by the AOJ. In any case, I cannot imagine going to the BVA with anything but a Legacy Appeal. Without a hearing or an opportunity to point out the rating decision errors in front of the "only fact finder", how would you expect to win? Take an HLR when it is given and is not in error. They are only for obvious errors. But never an AMA BVA review.
  15. I had a supplemental appeal open where I submitted in the evidence for the HLR but that was closed two days after I already submitted in the evidence saying it was under the HLR avenue so they closed it with the evidence already into my file. Might get lucky
  16. Correct, by Broken soldier. HLR "specifically excludes new evidence". I am actually not sure what happens when the Vet tries to submit new evidence to a HLR. I have "heard" that they either drive toothpicks under the Veterans fingernails until they promise never to try to submit new evidence on an HLR again, or take your first born child. Broken Soldier may know which, but I would not recommend giving up your children. There is some talk they may convert an HLR to a supplemental claim or BVA appeal, but that has never been proven to suit my taste. For now, if you do try to submit new evidence with an HLR, wear thick gloves so that toothpicks can not be driven under your fingernails, and tell your first born children to hide whenever the VA (or the FBI/police comes around. In the future, however, take NOTE: Now new evidence with an HLR.
  17. HLRs by legal definition, can’t introduce new evidence. They only consider what was in the claim at the time it was denied, a review of the claim as it was. Superman’s can consider new evidence that is new and or relevant, though.
  18. While in the process of waiting for the hearing I scheduled for April 2 I have some questions. So after filing the HLR I currently have had two claims closed and one still open. The evidence I submitted in the claims can it now be used and brought to light proving my claim in the HLR since it’s all in my file now? Got a text this morning to schedule the conference for HLR from Nov 20
  19. Yes, I have an appointment on April 30th with my PCP dedicated for the NEXUS letter, and of any required exams he will do. My PCP is one of the rare ones who is very accommodating to the patient. That’s great to hear you had a good experience with the VES. My initial experiences with the “old school” VA doctors in 2002, wasn’t great at all.
  20. I have saw that one before. It's one of the best ones I have seen of the song. The back up music is so good to his song.
  21. You are preaching to the choir hear hat Hadit.com. I like VES they sent me to a top notch Phd. for my PTSD exam. Some others have not had as good as luck. Yes you should be able to bring your wife in with you one the exam. I am sure she has something to contribute to it and make sure she does even if he doesn't ask. If you haven't filed any thing after 2019 in the mew AMA a lot has changed as to what form and when to file. Like when to file a Supplemental Claim. (any time with new evidence.) I cant remember where I saw it but if I can find it I will post a link hear. You PCP needs a “hands on” evaluation" because its harder for them to challenge his Nexus. Some say going after additional service connected conditions, when already at 100%, is not worth the effort. That is BS that well meaning or lazy VSO tell vets. Hears an example. Say you are under 10 yeas ratted and married. if you were to pass away unless it was from one of your SC disabilities on the death certificate it will be hard for you wife to get DIC that she deserves. After the 10 year mark it is much easer. Further more it will open up benefits to other SC stuff. Just ask broncovet or the other Mod's hear how many times they have answered that questions. (Not that it's a problem that's what we are hear for.)
  22. The compensation that the United States pledged to pay to veterans pursuant to 38 US Code § 1131 for personal injury or diseases that occurred during their active military service was not made to compensate the veteran for the disability, but rather was offered by a grateful Nation to compensate the disabled veteran for the impairment suffered to their earning capacity resulting from such injuries in civil occupations. With that said, your age or the length of time since the onset of the injury is not relevant and doesn't support a denial. If the disabling injury occurred during service then you would be entitled to finding of service connection, even if the injury is determined as non-compensable. If you honestly feel that tinnitus it is affecting your earnings capacity, then talk to a VA claim lawyer about filing a Supplemental Claim. Not to change the subject, but I use music to treat my tinnitus, here's a link to a song I would recommend.
  23. Is it possible to shoot you an example of a NEXUS letter I wrote, to assist my PC, in developing HIS NEXUS letter, via e-mail, text or messenger. It is somewhat sensitive and really don't want it public. I truly understand if you choose not to. Thanks for the prior assist.

    1. Rattler

      Rattler

      Yes I may have one or two that different ones that you can incorporate the wording in it.

  24. Yah the VA changed some of the rules about a year a go or so. I have seen a lot of people getting denied for the same reason you did. They have been giving a lot of 10% for service connections if not 0%. Watch this video. https://youtu.be/6_KEM4OzyWg?si=OhBJXhw4Qq3CBz4G These may be helpful. Evaluation of Hearing Impairment of Auditory Acuity-S4_85.pdf Exceptional Patterns of Hearing Impairment-S4_86.pdf Schedule of Ratings - Ear-S4_87.pdf
  25. Maybe that question was not clear. Let's see if this help... ======================================== The veteran files a claim for an injury to this [L] foot and injury to his [R] foot, claiming that medical treatment records while in service would affirm service connection. An C&P exam was scheduled by the RO. The C&P report contains the diagnosis of bilateral planter fasciitis.. (There is no notation in the C&P exam of any surgical treatment on either foot.) The C&P also lists plantar fibroma under the diagnosis with comment it is not service connected. * The C&P exam report does not that the veteran walks with a normal heel strike and toe push off. The RO decision finds injuries were service connected and assigns a rating of 10% for bilateral plantar fasciitis. ========================================= So my question is whether anyone see anything wrong with the rating 10% for bilateral plantar fasciitis? Since I am not trying to play a got you game, but I would like your "pick their brain". You can pick mine if you want but be forewarned to expect slim pickens. \,
  26. Impairment of Auditory Acuity See the VA attached documents. Evaluation of Hearing Impairment of Auditory Acuity-S4_85.pdf Exceptional Patterns of Hearing Impairment-S4_86.pdf Schedule of Ratings - Ear-S4_87.pdf
  27. If you think your life or health is in danger, call 911 or go to the nearest emergency department. You don’t need to check with us first. But if you go to a non-VA facility—even one that’s in our community care network—you must follow certain rules so that we can cover the cost of your care. Keep reading on this page to learn what you need to know if you go to a non-VA facility for emergency care. Find VA and in-network emergency care What to know if you go to a non-VA facility for emergency care The facility must be an emergency department We can only cover the cost of emergency care at an emergency department. An emergency department is a facility that has the staff and equipment to provide emergency care (like a hospital or free-standing emergency department). Urgent care facilities don’t qualify as emergency departments. If you’re not sure what type of facility you should go to, we can help. Learn more about choosing between emergency and urgent care We must get notified of your care within 72 hours Ask the provider to notify us right away in either of these ways: Through our VA emergency care reporting portal, or By calling us at 844-724-7842 (TTY: 711) We must get the notification within 72 hours of when your emergency care starts. We prefer that the provider notify us. But if they don’t, you or someone acting on your behalf can notify us instead. We can only cover emergency care when you meet certain requirements Keep reading to learn more about eligibility requirements for emergency mental health care and other types of emergency care. Emergency care eligibility requirements Eligibility for emergency mental health care In most cases, we will provide or cover the cost of your emergency mental health care and up to 90 days of related services—even if you’re not enrolled in VA health care. If a health care provider or a trained crisis responder determines you’re at risk of immediate self-harm, we can provide or cover the cost of your care if you meet at least one of these requirements: You were sexually assaulted, battered, or harassed while serving in the Armed Forces, or You served on active duty for more than 24 months and didn’t get a dishonorable discharge, or You served more than 100 days under a combat exclusion or in support of a contingency operation (including as a member of the Reserve) and didn’t get a dishonorable discharge. You meet this requirement if you served directly or if you operated an unmanned aerial vehicle from another location. If you go to a non-VA emergency department for help, tell the staff you’re a Veteran. Ask them to contact us right away. Eligibility for all other emergency care General eligibility requirements By law, we can only cover the cost of your care at a non-VA emergency department if you meet all of these requirements: You’re enrolled in VA health care or you have a qualifying exemption from enrollment, and A VA health care facility or other federal facility that could provide the needed care wasn’t “feasibly available” (meaning it was too far away for you to get there fast enough to get the emergency care you needed), and A person with an average knowledge of health and medicine (called a “prudent layperson”) would reasonably believe that a delay in seeking care would have put your life or health in danger, and You meet our other requirements based on your specific situation—including the time limit for us to receive your claim. Keep reading to learn more about requirements for different situations. Note: We only cover non-VA emergency care until we can safely transfer you to a VA or other federal facility. The only time this rule doesn’t apply is if the community provider contacts us and we can’t accept your transfer. More emergency care coverage requirements In addition to the general eligibility requirements, you must also meet these other requirements based on your specific situation. What to do if you’re charged for emergency care If you get a bill for emergency care at a non-VA facility and you think we should cover the cost, we can help. Call us at 877-881-7618 (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. We’ll go over the charges with you and help figure out who should cover the cost of your care. We can also help resolve billing issues with community providers. Find out how to file a claim for reimbursement of non-VA medical expenses. View full record
  28. If you think your life or health is in danger, call 911 or go to the nearest emergency department. You don’t need to check with us first. But if you go to a non-VA facility—even one that’s in our community care network—you must follow certain rules so that we can cover the cost of your care. Keep reading on this page to learn what you need to know if you go to a non-VA facility for emergency care. Find VA and in-network emergency care What to know if you go to a non-VA facility for emergency care The facility must be an emergency department We can only cover the cost of emergency care at an emergency department. An emergency department is a facility that has the staff and equipment to provide emergency care (like a hospital or free-standing emergency department). Urgent care facilities don’t qualify as emergency departments. If you’re not sure what type of facility you should go to, we can help. Learn more about choosing between emergency and urgent care We must get notified of your care within 72 hours Ask the provider to notify us right away in either of these ways: Through our VA emergency care reporting portal, or By calling us at 844-724-7842 (TTY: 711) We must get the notification within 72 hours of when your emergency care starts. We prefer that the provider notify us. But if they don’t, you or someone acting on your behalf can notify us instead. We can only cover emergency care when you meet certain requirements Keep reading to learn more about eligibility requirements for emergency mental health care and other types of emergency care. Emergency care eligibility requirements Eligibility for emergency mental health care In most cases, we will provide or cover the cost of your emergency mental health care and up to 90 days of related services—even if you’re not enrolled in VA health care. If a health care provider or a trained crisis responder determines you’re at risk of immediate self-harm, we can provide or cover the cost of your care if you meet at least one of these requirements: You were sexually assaulted, battered, or harassed while serving in the Armed Forces, or You served on active duty for more than 24 months and didn’t get a dishonorable discharge, or You served more than 100 days under a combat exclusion or in support of a contingency operation (including as a member of the Reserve) and didn’t get a dishonorable discharge. You meet this requirement if you served directly or if you operated an unmanned aerial vehicle from another location. If you go to a non-VA emergency department for help, tell the staff you’re a Veteran. Ask them to contact us right away. Eligibility for all other emergency care General eligibility requirements By law, we can only cover the cost of your care at a non-VA emergency department if you meet all of these requirements: You’re enrolled in VA health care or you have a qualifying exemption from enrollment, and A VA health care facility or other federal facility that could provide the needed care wasn’t “feasibly available” (meaning it was too far away for you to get there fast enough to get the emergency care you needed), and A person with an average knowledge of health and medicine (called a “prudent layperson”) would reasonably believe that a delay in seeking care would have put your life or health in danger, and You meet our other requirements based on your specific situation—including the time limit for us to receive your claim. Keep reading to learn more about requirements for different situations. Note: We only cover non-VA emergency care until we can safely transfer you to a VA or other federal facility. The only time this rule doesn’t apply is if the community provider contacts us and we can’t accept your transfer. More emergency care coverage requirements In addition to the general eligibility requirements, you must also meet these other requirements based on your specific situation. What to do if you’re charged for emergency care If you get a bill for emergency care at a non-VA facility and you think we should cover the cost, we can help. Call us at 877-881-7618 (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. We’ll go over the charges with you and help figure out who should cover the cost of your care. We can also help resolve billing issues with community providers. Find out how to file a claim for reimbursement of non-VA medical expenses.
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