[Virtual Va]

Hello Mike S.

I was once a Veterans Service Representative (or VSR) once upon a time, but I left the VA because... well.....let's just say management has no idea how to treat their employees. I've often thought that it is as bad working for the VA as it is trying to file a claim with the organization. But I still have friends that work there and they keep me up to date on the new things happening (or supposedly going to happen in the future). Anyway....on to your question/comment.

E-benefits just recently updated their system. Now you have something like 8 steps in the claims development cycle, where as under the old e-benefits system, you only had 4. When you (the veteran/claimant) tell VA that you received treatment at a VA Hospital or Outpatient Clinic, by law, VA has to obtain those records, or keep trying until they get a negative response (such as they were somehow lost or are unavailable). A few years ago, we (VSRs) had to actually print out all records from the VA treatment center(s) noting your condition(s). That sounds easy for one or two conditions with a few years of treatment. However, we have a lot veterans who use nothing but the VA for their healthcare needs and would have 20 or more conditions treated at VA and claimed for VA compensation claims. As you can imagine, that creates a lot of paperwork. Some days, I would sit and do nothing else but print medical records from our electronic system.

Now the VA is trying to move into the paperless era, even though the organization really isn't prepared to do so. So what they have to do now is copy your treatment records from one electronic system and paste it into a document into another electronic system (i.e. Virtual VA). I think that sometime in the future, Virtual VA will be the virtual claim for all veterans as you can electronically store service records, DD214s, Rating Decisions, and treatment records all on one database, but don't take my word on that just yet. It's is still in the beta process.

As for your C&P exam situation, that depends. I agree with T8r that a medical opinion may have been needed, but it also could have been something scheduled in error. If you recently had a VA exam (within the past few months), the VSR may have forgotten to send the c-file, or the exam itself may have been inadequate to make a rating decision off of. VA doctors get paid for C&P exams whether they're right or wrong, however, they get paid on a hourly basis. If they are only paid for two hours to give you a VA Exam and your exam starts to go over, they don't get paid for that extra time,which is why sometimes they will rush the exam to finish on time. Also, they don't get paid when veterans fail to show up to a scheduled C&P appointment, which is why they ask that you please be on time. I wouldn't worry about it though. VA will notify you if you need to make it to another exam.

The benefit to your claim status being in the stage of "Preparation for Decision" is that it should be in a Rater's hands relatively soon, as I have heard word that all VA Regional Offices are scrabbling to find claims to make a decision on and meet monthly quotas. The bad news is that you are just stuck waiting because it is unknown how long that will exactly take. It may take less than 5 days or it may take more than 30. E-benefits will not provide you with this information because the system doesn't know. It can give you a national average waiting time, but that may not be the average for your particular state's Regional Office. My advice to you would be that if it takes over 30 days and your claim hasn't moved to the next phase of "Pending Decision Approval", try and contact your Power of Attorney (POA) to find out why your state's Regional Office has not made a decision yet, and if that doesn't work, use an IRIS inquiry at www.iris.va.gov and click on the link "Ask a Question" and submit you question concerning your claim status there. You are supposed to receive an answer from the VA within 5 business days of submitting an IRIS request and best of all, it's in writing. It may even help to move your case into a rater's hands the day VA receives your inquiry. When your claim moves to the "Preparation for Notification" phase, that will even better news to you because the VA has made a decision on your claim and is getting ready to mail it to you. It should only take 3.5 days to get the decision from a rater to a VSR to type of the notification letter and mail the decision to you because if it takes longer, then the station can be written up for holding on to your decision to long. Hope this helps...

WorkAHolic

[Central Sleep Apnea]

Following this discussion. I was diagnosed last week with severe apnea ( I dont' know if it's obstructive or mixed) I take hydrocodone, meloxicam, gabapentin for a back injury, and zoloft for depression. I found in my medical records where I was prescribed elavil in 2002 by my (then) army PCP before I discharged for sleep problems as well, but I never claimed it, then.

Sorry for the late reply, but I just recently celebrated a birthday and as the nickname says, I am a "workaholic." Sleep apnea is a horse of another color. I can tell you what I've seen at my regional office relating to the subject, but the majority of the time, you are going to need a medical opinion to link it to your military service (if there is no record of sleep problems or a diagnosis in service). You can try and link it secondary to taking medicine prescribed for a service connected condition (for example, I have seen tinnitus secondary service connected for hydrocodone usage for a service connected back condition. There have been studies that link hydrocodone(due to side affects) and tinnitus); however, even with all this being true, it ultimately comes down to the VA examiner you have and if in his/her opinion that condition is caused by medicine usage for a service connected condition. And, of course, it all depends on the luck of the draw with who you get as your VA Examiner, as you may already know. With that being said, let me check with a friend of mine at the VA Regional Office near me and I will get back with you. I will tell you that VA has proposed (but not fully implemented) where you will be able to go to your private doctor with a VA Exam worksheet and have him/her give you the medical opinion. Although this seems like a good idea, unfortunately, if you live in my state, you have to "doctor hop" to find a doctor who would even perform the exam because most doctors here wouldn't want to get involved because of possible legal issues. Let's not even mention the medical insurance part of it. Check back with me soon.

[Service Connection]

Hey there ....

Unfortunately, SSD probably does work faster that VA, but that could be due to the fact that SSD employees only get called on an error in the claims process only when it harms the claimant; whereas the VA loves to call errors on their employees all the time just because they can. If your claim was deemed to be a true Camp Lejeune case, then it most likely has been transferred from your home state regional office to the Louisville, Kentucky VA Regional Office (this is where all Camp Lejeune cases are supposed to be worked for expeditious processing). When you receive your VCAA letter (unless they have already sent you this, then they will notify you via there notification letter with rating decision), they will tell you in some shape or form (it will probably be the first paragraph in bold, black ink) that a special team at the Kentucky VA Regional Office has been designated to process your claim and to please send all information to them. If you have a POA, I would suggest that you send them any copies of evidence you wish to submit to VA so that at least something is on file. The VA has been notorious in the past for losing evidence or continuing to process claims with evidence sent by the claimant still being "cycled " through their mail system. As far as time goes, that is a "depends" situation. By "depends" I mean did VA order the right exam?; if they did, did they request a medical opinion if needed?; did the examiner provide rational for his/her medical opinion if requested?; was the exam adequate for what the veteran claimed?; were there any issues the veteran claimed that were not addressed?; any special issues claimed that require special development?; did VA forget to develop for something?; These are only a few of the many problems your claim could run into, but I threw these out there because these were issues I commonly came across that held up veterans' claims. As far as time frame goes, could be soon, could be later. I would imagine that VA is making sure that they thoroughly developed / accurately reviewed your claim, since your claim needed special development (i.e. Camp Lejeune). It is difficult to tell you in days what to expect, but I would guess that as long as the development for your claim was done fairly smoothly, you are probably looking at between 30 and 125 days. I would use the iris inquiry/ask VA a question to check the status of your claim at iris.va.gov. This is a little more detailed way of finding out the status of your claim than by using e-benefits.

[I Did Not Claim Tdiu But They Say I Did]

What probably happened when you sent in your new claim for compensation, somewhere in your statement you either said something about presently not working (or not being able to work) or VA read your statement and inferred from your hardship that you were not working and "inferred" a claim for IU. As a former VSR, I was told to look for this because I would have an error called on me if it slipped by. A majority of the time, veterans are not really claiming "IU" per say; however, VA does this to catch the small percentage of veterans that do not know about this benefit. As far as IU goes, all you really have to do is call the 1-800 number, or use IRIS at iris.va.gov (and click on ask a question), or even your POA (however, I believe the first two options are a little quicker in my opinion), and state that you are not filing a claim for Individual Unplayability, if that is what you choose to do. Please keep in mind that I don't know your specific situation, so I do not know if you would qualify for IU, but every time a claim for VA benefits is received after a claim is initially filed, that just pushes you back that much further because the VCAA time requirements start over for that specific claim. Additioanlly, you can waive your 30 day VCAA requirement (through the three options mentioned earlier) to help speed up the time it takes to make a decision on your claim, but make dang sure that you have turned in all evidence (via certified mail in this case) in support of your claim, and please ask your VSO if there is anything in your VCAA letter that you don't understand before you do this. Hope this helps. Good luck with your claim!

[Hello]

Sorry to hear your troubles. First and foremost, do not rely on e-benefits because it's only going to frustrate you. E-benefits will tell you that your claim has been moved in the "Decision" phase of the claim's cycle with a brief statement that "your claim has been moved to the Decision Phase, which on average takes between 16 to 32 days to decide your claim" (base on some fudged national number they've concocted); however, what they don't tell you is that they are "supposed" to work claims in date-of-claim order. And more than likely, you are waiting for a Rater to pull his/her work list which will eventually have your claim number on it or pull your file out of some cabinet with a hundred other c-files so that they can work it. Put simply, more than likely there are a lot of claims at that Regional Office in the same status that are ahead of yours, either by a couple of days or even a couple of months, and unless there was erroneous development done or an inadequate exam performed, you will probably have to wait until your number gets called unfortunately. Also, with the holidays upon us (such as Labor day, or last minute summer vacations), this could put your claim a little behind schedule as well. I know your claim is about to be 1-year old, but where I used to work, it wasn't that uncommon to have several over a year old claims, especially if a file was transferred from another regional office. I do not know a lot about the Houston Regional Office, but I have heard that they were not very timely with processing claims. Additionally, e-benefits is supposed to have a link in the same area which tells you what stage of the claims process your claim is currently, that would let you know what the last action the Veterans Service Representative or Rater did to your claim, such as "Today, I closed out all tracked items and made claim ready-for-decision (RFD)" or "Requested another VA exam because in the last exam, the examiner failed to provide a proper medical opinion for his reasoning (basically, an inadequate exam)." Although, they claim this is there somewhere in e-benefits, I haven't been able to find it yet. What I would do if I were you is contact the VA via IRIS inquiry (and here is the link https://iris.custhelp.com/ ). You may need to copy the link and paste it into your browser. Once there, click on the link towards the bottom right where it says "Ask A Question" and has a picture of a keyboard. Submit your personal information and a brief statement of your situation and that you have already tried e-benefits to no avail. Just keep it short and simple. IRIS is great because they have to respond to you with in a few days and it is in writing. You can also call the VA's 1-800 number, but I find it frustrating to talk to them because many of their benefits counselors are new and don't know what they are talking about (at least with my experiences). Even better, the IRIS inquiry gets filed in your claims folder and you may actually get your claim rated faster because a rater may actually look at your file "out of turn" and see that you have submitted all evidence to VA (assuming), and that you do not wish to add a another contention to your claim, which would cause you to wait even longer than you are, and decide to go ahead an rate it.. Also, VA's fiscal year is will be up at the end of September, and all regional offices are in conducting a big push to rate as many cases as they can to meet or exceed station production goals. Best of luck to you!

[Assistance In Ptsd Claim/ Increase Rating Claim]

Hello to you too,

From what I think I've read (and please correct me if I am wrong), but it sounds like you are filing for PTSD for the first time with the VA correct? I will be assuming so for the purposes of this post. Additionally, what type of PTSD are you claiming? By type, I mean that the VA recognizes PTSD as combat PTSD (engaging in actual combat with the enemy), non-combat PTSD (such as witnessing an act of horror [air plane crash, ship sinking, etc.] or "being in fear of your life"), and personal trauma PTSD (such as being raped, sexually assaulted, getting jumped). The VA Regional Office of your jurisdiction should address this fact if you did not specifically claim it, unless you have one of the service medals from your DD 214 outlined in VA manual M21-1MR, Part IV, Subpart ii, Chapter 1, Section D (here is the link, but is kind of tricky to navigate so I have also posted the info below http://www.benefits.va.gov/WARMS/Site_Map.asp ) or they happen to look at your service treatment records (STRs) and find instances of combat, or they check the VA system that they look in for hospital records and progress notes and get the info from there. If VA can not find it in any of these places, in their VCAA letter to you they should have a couple of lines addressing "what type" of PTSD you are claiming so that they can do proper development. VA can also call you to get this information, as the new Secretary for VA wants to have a more outreaching appearance of VA representatives, but most likely look for it in the VCAA letter. If it is not there, do not necessarily worry, as they have probably inferred your type from one of the ways mentioned above. What I would worry about is the VA Exam (which for PTSD will be an exam with a medical opinion unless you had a medical diagnosis of PTSD in service, which most likely you don't). Reason being is that you may currently have a medical diagnosis for PTSD, but when you go in for an exam (or medical opinion in this case) and if you answer the exam questions for PTSD in a certain way, it is quite possible that the VA examiner may say that you were misdiagnosed with PTSD and suffer from major depressive disorder, or schizophrenia. Additionally, if it has been a while since you were discharged from service (i.e. 5 years or more) and you don't have a diagnosis in service, the examiner is going to have to say that your PTSD and/or "your stressor(s)" are a result of your service on active duty. Sometimes they do, sometimes they don't. It all boils down to if you have a good examiner or not. Your stressor is going to have to be conceded for VA to grant you PTSD. If you have one of the recognized combat medals listed below, VA will concede your stressor without a medical opinion, but you will still need the opinion to say that you have PTSD. Otherwise, you will have to fill out VA Form 21-0781 (for combat related PTSD) or VA Form 21+0871a (for all other types of PTSD) and give your statements of what caused your PTSD during your service and VA will go and try to verify it.

Now as far as getting them to recognize PTSD earlier, Veterans Service Representatives are supposed to look in your STRs to look for symptoms of possible PTSD to help in the development in your claim, but unless you just got out one year ago, or VA made an systematic error after granting you PTSD, you most likely will be granted from your date of claim (especially if it has been a while since you separated from service).

You did well to have VA provide you with a copy of your claims folder. I would take it one step further and have the VA hospital(s) you visited provide you with copies of your medical records, progress notes, etc. as well, especially if you are planning to continue to file disability claims with the VA. All you have to do is sign a release of information form and tell them the dates you visited. And the best part is that it is free! You might ask why, but trust me it is worth it. You can't always trust VA to look at these records and be able to read the correctly. I know it sounds confusing, but believe me, I had a claim on appeals for five years and I kept it from going to the Board of Veterans Appeals because when VA would send me denial letters stating that I did not have a current diagnosis for a claimed condition or current treatment for a claimed condition, I would go to my VA records and highlight what they were supposed to have found and send it back to them.

As far as increases go, if you are service connected for a condition, all you have to do is file an increase with the VA, and they automatically schedule you for a VA exam. You may not always be granted the increase because you do not meet the rating criteria (as someone else had mentioned in an earlier post), but you at least get the exam. I would never tell a vet to not file for an increase, especially when they feel that their service-connected condition has gotten worse, but I would advise caution with certain conditions (such as knees, anything with your back, most mental conditions, and some others) because sometimes you may go in for a VA exam after filing for an increase, and a VA examiner will check your ranges of motion, or ask you questions about your mental state, and will note that you have shown improvement or signs of recovery from your last exam, even if you feel more pain. This could result in VA proposing to reduce your disability rating, but they won't ever drop you below 0%. Also, sometimes how you answer the medical examiner's questions could prompt him to state that you have shown signs of improvement. Just do what you feel is best and absolutely go in prepared. It would take to long for me to give you any more advice on this subject on this particular post (as it is already long enough...lol.) but just message me if you have any specific questions, and I will try to help you the best I can.

As far as your other conditions go, just file. Let the VA tell you that they are not related to your service. Who knows, even if you don't have a diagnosis in service of GERD or hiatal hernia, you may still have symptoms in your STRs and might possibly be able to get service connected with a medical opinion. As far as arthritis goes, if you are already service connected for your back and you have arthritis in your back, file a claim for "arthritis in your back, secondary to your service connected back condition." I wish you the best of luck in your pursuit of service connection with the VA, and if you have any other questions you would like me to answer, just ask. P.S. I worked for the VA as a Veterans Service Representative a while back before I quit and found another job that I really like doing...lol... Good Luck!

Here is that info I was talking about before. They also now recognize the Vietnam Service Medal per a training letter.

13. General Information on Developing Claims for Service Connection for PTSD, Continued

d. Decorations as Evidence of Combat

When a Veteran has received any of the combat decorations listed below, VA will presume that the Veteran engaged in combat with the enemy, unless there is clear and convincing evidence to the contrary:

[New In Town And]

Welcome Aboard! Glad to have you with us. I look forward to your input.

Thanks. I am still a little confused on how to post, and I do understand that my posts will need to be approved by an administrator, but that is o.k. I just wanted to share this link because I didn't see it on the site and it may have useful info to this site and for other vets.

Here is the link.

http://www.benefits.va.gov/WARMS/Site_Map.asp

It is a link to the online version of the VA manual (both the old M21-1, M21-1MR (the manual rewrite which VA currently uses), and M21-4.

Also, some other food for thought.

1) VA is planning to automate all dependency claims by this coming October to help with the backlog.

2) It has not been approved yet, but soon, VA will allow veterans to go to private physicians (with the correct VA Exam form) to have a C&P Exam instead of having to wait to have one from the VA. This is optional. (also to help combat the backlog)

3) VA is planning to go paperless sometime next year (2012) for all regional offices. I don't know exactly how this will work, but when I hear more information, I will let you know. Currently, there is one regional office that is already paperless and they say that everything is "running smoothly."

[New In Town And]

Hey everyone,

I'm new to this whole "blog" and "forum" thing, but here goes. I am 32 years old. I served in the Army from 2001 until 2005 and was apart of Operation Iraqi Freedom II. I worked laying tile briefly after I was discharged from service, then decided I need to go to college to get a degree after I was laid off because of the slow economy. By luck, I happened to pick up a work study job at the University I was attending and then was able to transfer that work study position to the Department of Veterans Affairs, Veterans Benefits Administration. After about a year, I was hired on as a Claims Assistant and then promoted to Veterans Service Representative for 4 years. I finished my Masters earlier this year and decided to leave the VA to go pursue something that I wanted to do like own my own business. I wouldn't call myself an expert, but I do have a lot friends that still work at the VA , and I have 5 + years experience myself. If anyone has any questions, I will do my best to answer them if you would like or I will simply tell you "that I don't know." I understand how frustrating the claims process can be because I personally had my own battle with the VA, and I was an employee. However, I appealed their decision and I can tell you my claim stayed at the regional office of jurisdiction and the 4+ years it was on appeal, it never went to the Board of Veterans Appeals because of all the errors that I had pointed out to them. Anyway, if you have any questions just ask. I will post my own blogs about the VA (nothing really specific and nothing really negative, just my point of view) from time to time and invite any of you to join in.

WorkAHolic