NavyWife

My so-called FDC has taken almost 9 months and is still at gather evidence stage. My claim is for an increase. It is pretty cut and dried. Also, just because your evidence is before the VA does not mean they have to consider it. They may have to list it, but they can twist it, misrepresent it, and just ignore it.

John

You expressed concern that you could not see the medical exam records associated with your claim when you looked at it. It is my understanding that the claim form you submitted will not serve as a link/gateway to information on your claim. It is a static record of what you submitted. Likewise you will generally NOT be able to see the contents of evidence being evaluated for your claim via ebenefits. It will give you a generalized status of claim that may or maynot be accurate. The exam notes if performed in a VA facility by VA docs, should be viewable in 'myhealthy vet"'s blue button section(medical records download). You will only be able to access that if you have a preferred/verified account with my healthy vet. You can set up and verify your account through your VAMC and sometimes at your local VA clinic.

As for your 10% rating, it was no error, it was an intentional act by the VA to lowball you and see if you will go away smiling and ignorant. They did me the same way 24 years ago, gave me a 0% rating when at 22 I had arthritis on x-ray in my spine, but they called it a "Bone Condition". I was trying to focus on transitioning to being a civilian and thought it was great they would give me medical care for my back if it was a problem later. 18 years later I asked about getting some physical therapy through VA and was told I was not eligible for medical care because I was rated 0%. Found Hadit and started to fight. Found out I didn't have a "bone condition" but arthritis, found out I had hypertension and an enlarged heart in my Service medical records. FOUND OUT THEY ARE NOT LOOKING OUT FOR VETERANS.

My ratings went from 0% to 40% to 60% to 90% then to 100% with three issues still un-resolved. When all items are rated properly I should be SMC-S permanent and total.

Welcome aboard and there are many here that will assist/mentor you and provide the knowledge you need to advoacte for yourself.

The VA routinely denies TDIU using that exact quote, 38 CFR 4.16(a). They used it on my claim back in 1991 and, at first, I agreed w/them, until I read the whole 38 CFR 4.16. They purposely deny claims all the time, by misleading the claimant. The claimant must appeal that decision and request an extra-scheduler rating, as they are instructed not to bring extra-scheduler up, unless the claimant asks for it.

I assisted a local VFW volunteer VSO win TDIU who had gone to his congressman twice for help. The VA kept telling them that 50% was the maximum allowed for a skin condition, which was true but they never mentioned extra-scheduler rating. He won $72k retro and could've have won more but he didn't want to rock the boat.

pr

I have thought about this situation for myself and came to the conclusion that I would volunteer. No better way to show you care and this is how you can help others. It would also be a great example for your children.

Wasn't the evaluation a C&P exam? Did you see a psych doc or neurologist at VA? They are the only type of docs that can do a TBI exam for rating purposes.

Did they ask you the long list of questions on the ECI table? Things like, do you get lost easily, even when using navigation systems?

The Administrative Review is a step in the process of the rating decision and is not a type of claim. It can be initiated by the Vet or the RO. Where I have seen it used is when a Request for Reconsideration (re-open of the claim within one year of the original decision date) is submitted. Then a senior member of the staff reviews the decision if a modification has been made or the rating decision does not need to be changed.
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3.05 Administrative Review a.Definition An administrative review is initiated after a formal decision is made. The review provides the resolution to uphold or overturn the formal decision. It focuses on questions regarding policy and procedures, application of the laws, regulatory guidelines or directives. b.Timeline for an Administrative Review An administrative review must be submitted within one year from the date of the written notification of decision to the Veteran. The Veteran must be informed of the decision for an administrative reviewconducted by the Director of VR&E Service or a VREO within 90 days of receipt of request. (38 CFR 21.98) c.Veteran Notification of the Administrative Review Outcome The RO notifies the Veteran in writing with the outcome of the administrative review conducted by VR&E Service or the RO.

vet201060, (and all others on Hadit)

You need to get copies of ALL of your VAMC medical records including: all of the imaging, medical and mental Progress Notes, Problems List, Labs, Medications, Procedures--EVERYTHING! If you have had any kind of operation or procedure or have been admitted to the facility, you will have paper records and you want those also.

Download VA Form 10-5345a INDIVIDUALS' REQUEST FOR A COPY OF THEIR OWN HEALTH INFORMATION. It is attached to this post. The ROI at your VAMC will provide you with the form also, but I prefer to take the time to fill it out exactly as I want it. You decide on that.


FACILITY WHERE TREATED: YOUR VAMC

DATES OF TREATMENT: FROM THE FIRST DAY YOU WENT TO THAT VAMC TO PRESENT.

PUT A CHECK MARK IN "OTHER." Then in the box write:

"ALL Records maintained at this facility including, but not limited to, all imaging, all physical and mental health Progress Notes, Problems List, Labs, Medications, List of appointments, and all other electronic/paper documentation of my treatment and care at this facility."

PUT A CHECK MARK IN "IN PERSON." Please release this information directly to me in digital format on CD.

Sign and date the form in blue ink.

Go to the Release of Information Office and present the completed form. Inform the person handling this release that you want all of the imaging on CD as well. That person will most likely send you to the Imaging department where CDs will be made of all MRIs, CTscans, X-rays, etc. Some times the Imaging Department will ask for a separate release form. A signed original copy of the form you gave the ROI will usually suffice.

The ROI will have to get permission from your mental health care provider to release any MH information. This is usually not a problem. However, you seem to be in a pissing contest with one particular MH provider. If it becomes a problem, you can have the information released to another person (your wife, parents, etc. or another provider). I would only involve the Patient Advocate if you run into static from this individual. In that case, I would not only involve the Patient Advocate, but I would also contact the OIG at your RO and the:

Office of Medical Medical Inspector

http://www.va.gov/health/medicalinspector/

1 800 634-4782

If you are forced to involve the OIC and/or OMI have all your ducks in a row! As others have posted, you absolutely do not want to get labeled as "only a drug seeker." How you explain your situation will determine how you are labeled. If you want assistance in preparing your complaint, PM me.

My ROI and Imaging does this right when I am there. I have heard that many others have had to wait for the CD(s) to be mailed to them. The MRIs etc will come on a disk with a "viewer" program that will run on any Windows based computer. (I am not sure about Apple equipment.)

Once you have your records from the beginning of time (at this facility), all you have to do each time you get treatment there is to go to the ROI and fill out the same form requesting "ALL records from the last release to present."

Hope all works out well for you!


vha-10-5345a-fill.pdf

*update*

I found out today that I have my C&P scheduled for March 13th and my claim is still categorized as a FDC. Hopefully this will soon all be done!

If you're different than when you went in is all that matters; your claim is as valid and important as anyone else's and deserves that kind of attention.

Unfortunately, pretty much none of us expected to have to become lawyers to fight for benefits we were assured would be there if we ever needed them; this applies to SSDI as well.

So- there are many missteps and delays. But you are among friends and we will help you. Cool that you're looking to help others too.

Good luck!

Back in the day, important data was routed over leased lines that were completely secure.

It's much less expensive to route traffic over the internet; the trade-off is it's also very vulnerable to interception..

Like John said, nothing is secure.

I filed for TDIU when I was 30%. I got new evidence and was bumped up to 70% but denied TDIU. When I got TDIU on appeal the effective date was the date I first filed when I was 30%. As soon as you meet part B. of the TDIU reg., file for it even if you get denied at first. Every vet who is unable to be gainfully employed due solely to SC condition(s) is entitled to TDIU. You have to go to the floor on this, but if you can show it you will win because they will bump you up to 70% and then grant TDIU.

Kate


If you have filed your notice of disagreement you can hire a lawyer to help you. Then you can put this on the lawyer's plate. You can still get your IME's/IMO's and , in fact, your lawyer may know some doctors who know how to write decent IMO's. You don't need to do all this on your own. The lawyer gets paid out of retro pay, so no money upfront.


John

This is an absolutely fantastic idea for anyone going into their C&P evaluation. Great idea!

Yeah well now it's off Admin Review. The whole claim went back to start, sitting at gathering evidence. Ha. I don't know what to think anymore. I am getting a private opinion though this time around. I already have a date to see my own psychologist.

oc Rehab was not feasible Solely due to your SCs, that is great evidence for TDIU

My VSO said not to submit that because they should already have it and it would only slow down the process? I thought that sounded odd, should I submit it now?

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Never assume that the VA has anything and never trust your VSO to send anything. Their tendency is to lose or ignore things for some reason. But it seems as though they put glue on the negative evidence. All they will do is send you back the duplicates if they already have it.

@NavyWife

Long talk with my wife and much emotions last night, I will be going to see a VA psyche doc on Wednesday about PTSD/TBI symptoms. I don't really know how I feel except I don't want to when I think about it, but I know my wife loves me and wants me to go for my health. Thanks.

@Berta

I see you are SC for the DDD, but not the knee

Both knees were damaged on active duty and documented. Left knee was a Grade II torn meniscus documented. The right was damaged (swollen and discolored) documented, and given 3 days R/R which never happened due to dive ops, which is no biggie cause that knee rarely ever hurts. The left I have had problems with since the damage mostly hitching and giving out.

I have a current claim for my L Knee and GERD. Those were put in in 2009 and somehow got dropped. So I put in for it last year which is probably why my TDIU has taken so long. Sorry forgot to mention that point.

oc Rehab was not feasible Solely due to your SCs, that is great evidence for TDIU

My VSO said not to submit that because they should already have it and it would only slow down the process? I thought that sounded odd, should I submit it now?

you should contact the former employer to see if the VA really sent them the form yet

I have tried to call Rob multiple times (my last employment was in 2006 with him). I am on great terms with him he called me 2 years ago and took me out to lunch seeing if I felt better hoping I would come back to work for him. So I know do not think he isn't dodging my calls.

The Deluca Factor

So is this High Blood Pressure or pain with range of motion? Sorry I will do more research.

Thanks for all the information, my wife says to thank you also.

Dan

Navy on the money as usual.

You're right on that!

BTW, the list of supposedly "missing items" ticks me off too! One option is to drop them an IRIS email and ask if you owe anything...that will confirm if they need anything from you or not, and you'll have it in writing.

Get a copy of examination asap. If it doesn't have the magic words of "at least as likely" or "more likely than not it may cause trouble for you.

Thanks NavyWife. I'm living proof that having a well documented case works. Perhaps this is why I've NEVER had a claim denied and know nothing about appeals.

You know your VA has the ability to write a perfect secondary condition opinion if they choose to do it. My PCP did if for me a few years ago when I wanted her to help me connect heart condition to DMII. Then VA changed their minds about helping vets do this, and I got a new PCP who was reluctant to stick her neck out for me. Since your claim is not final I don't think you have a CUE. The VA will not connect the dots for you even if it is obvious. That is why you get the private doctor to do it for you. This they will accept, sometimes. You get what you directly ask for from the VA. You have to know enough to ask, or they won't help you. This is my experience with all the conditions I have secondary to DMII. This is part of the learning curve at the VA.

Maybe if you can get it presumptive for your circumstances you can set an example for thousands of others. You never know with the VA.

That is great! I will write that move down in my list of "Things to do when VA tries to screw you"!

Seems like they cheat everywhere they can. First, wrongly deny as many times as possible. Second, ignore or lose your evidence. Thirdly, if they finally have to approve, then they try to give you a wrong effective date, hoping the vets won't notice.

Congrats on your well deserved win! & great job getting that correct effective date!

infantry10, on 25 Oct 2013 - 4:58 PM, said:
That was almost exactly what my IRIS response was. Only difference was, they say my RO is taking around 9 months to complete on a average claim. Sounds like they send emails based on a script.
I found that if I ask for specific details in my IRIS they tend to give you a more accurate and detailed answer. Sometimes it may take 2-3 replies to their original IRIS answer but in the long run, I've been more successful at getting a personal answer rather than the "cut & paste" versions of what they try to dismiss our question with.
Stay on them until you get a satisfactory answer. That's thy the IRIS is there.

Not much to add but encourage all to read my posts under OIF/OEF Veterans...Meaningful change starts with us!
LC

Great idea! However anything more than a page or two and the reader gets bored or distracted, even at the VA. I'd suggest a single page, outlining your claim, highlighting where the evidence can be found in your document. More than a few pages and they may put it aside and move on to a more simple claim, for now. jmo

pr

Somewhere you should add a statement similar to: "I am requesting the maximum benefits allowed by law, in addition to any and all benefits earned, both known and unknown, to me, at this time."