NavyWife

Thanks Aggie--
That's so nice of you to say!

Like any married couple we've certainly had our ups and downs. I guess you get the roses along with the thorns, right? Haha

As far as getting creative, I've seen some posts by Berta and asknod describing the very creative things they've done to get VA to do the right thing. So I'm just following their lead on thinking outside of the box!

I've got some more creative ideas brewing!

Have a great day!

Aggie--
I found this in the M21-1MR. My understanding is that from the moment a vet is rated 30% or more, that same effective date will be used to pay dependency claims, so long as the dependency claim is filed either with the claim or within 1 year after the rating decision granting the 30%. However, if the dependency claim was NOT filed with the original claim or was NOT filed within 1 year from the rating decision, then they would only pay from the date the dependency claim was submitted.

If they don't process it according to the rules, make sure you let them know.
Hope this helps and hope you get your backpay soon.


Change Date October 11, 2010
a. Effective Dates of Additional Compensation for Dependents
The provisions of 38 CFR 3.401(b) govern the effective dates for additional compensation for dependents.
b. Original Claim Showing the Existence of a Dependent
If an original claim shows the existence of a dependent and proof is received within the time limits under 38 CFR 3.109, pay the additional compensation from the commencing date of the Veteran's award, subject to the provisions listed in M21-1MR, Part III, Subpart iii, 5.F.35.d.
c. Veterans Initially Rated 30 Percent or More Disabled
Situation: A Veteran is initially rated 30 percent or more disabled.
Action: Notify the Veteran about
· additional benefits payable for dependents, and
· the evidence needed to establish
- relationship, or
- dependency, as in the case of a parent.
Result: If the Veteran submits the necessary evidence within one year of the date of the rating decision notification, pay the additional compensation from the effective date of the qualifying evaluation or the date dependency arose, whichever is later, under 38 CFR 3.401(b)(3).
d. Dependency Arising After the Effective Date of the Qualifying Evaluation
Situation: A Veteran marries, has or adopts a child, or his/her parents become dependent on him/her after the effective date of the qualifying evaluation.
Action:
· Pay the additional compensation from the date of the event, if evidence is received within one year of it. (However, 38 CFR 3.31 also applies.)
· Do not pay additional compensation for any period prior to the date of receipt of the claim if the evidence is received more than one year after the event, per 38 CFR 3.401(b).

Doing research on finding a good Doc for an IME here in Las Vegas and I came upon the National Directory of Independent Medical Examiners.

It looks to be pretty promising and lists doctors by state. It also lists their credentials, experience with IME's, etc.

Hope this helps!

I can only imagine how difficult the job of a RVSR must be. Even though I was previously a federal worker myself, I wouldn't take that job even if they paid me at the GS-13 rate!!

I think a claim that goes to VA needs to be like a present with a pretty bow on top, everything presented according to their guidelines & rules. Make your claim easy to approve.

What I've learned from reading the VBM is the most important part of your claim is the MEDICAL EVIDENCE. Do not leave the most important part of your claim up to the VA through their lousy, lowballing C&P exams if you don't have to. ( A few contentions do require C&Ps thru VA only). Take control of your claim by controlling the evidence. Then if the rater tries any funny business, you know exactly what the doc said & can prove it.

***Get 2 DBQ IME's for each contention. ***

By getting 2 instead of 1, the RSVR has to dispute 2 doctors opinions & would probably decide that is too much work.



Guidelines for IME/IMO

---Use the DBQ
http://www.benefits.va.gov/compensation/dbq_ListBySymptom.asp

---Refer to the VA rating guidelines
http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=38:1.0.1.1.5&idno=38#38:1.0.1.1.5.2.111

---Refer to the VA Clinicians Guide
http://www.vetsforjustice.com/C&P%20Service%20Clinician%E2%80%99s%20Guide.htm
or
http://www.americanbar.org/content/dam/aba/administrative/young_lawyers/project_salute/cc_d1_f1_cp_Pg_1-50.authcheckdam.pdf


Each DBQ must include multiple parts:
1). Diagnosis
2) Statement that Dr. reviewed the pertinent medical records or check the applicable box if available.
3) Nexus Statement from Dr. that says condition X is at least as likely as not due to condition Y.
4) Rationale Statement from Dr. explaining how he came to his conclusion on the Nexus. Must give specific reasons why one condition caused or aggravated the other.
5) Statement from Dr. regarding his medical degree and qualifications--or at least Dr. write up a statement using his official office Letterhead.

On most DBQ forms only #1 and #2 are part of the form. You must have your Dr. write in #3, #4 & #5 if they are not part of the form. I'm NOT saying a DBQ without each of these 5 Items can't be approved. I'm saying these are 5 of the things that if any of them ARE missing, VA has used as an excuse to deny a claim.

Once you get something SC at any percentage, then you can leapfrog to a high rating by putting virtually anything reasonable as secondary to Already service-connected Conditions. For example, any Secondary damage from an injury or traumatic event, any damage Caused by medication for service-connected conditions, any mental health issues Secondary to Service-connected conditions.

Once you get the first claim back, Hold off on filing an appeal as long as possible (up to the 12 month deadline) because appeals can take 4 years. Even a de novo DRO review may take 2 years. Instead file a new FDC for multiple secondary conditions-- with 2 DBQ IME's for each contention.

If an issue you filed for was not rated a high enough percentage then Request an increase and submit new and material evidence. An example of new and material evidence would be a DBQ from a new doctor.

For Direct service connection need to file a Statement of Support listing persistent and ongoing symptoms and stating condition has been chronic. For secondary service connection the condition does not need to be persistent or chronic. Edited to say, "Secondary issues do not need to be persistent or chronic SINCE SERVICE"

For direct service connection doc must state they have reviewed your STR's. For secondary service connection doc does not need to review your STR's--He only needs to review your pertinent medical records and must state that.

Cody,

You're ahead of the game but I still wouldn't rush to file; many of us here woulda traded a month or 3 in retro pay to have our claims settled sooner/without so much hassle.

That's because we had faith that The System would work as advertised on our behalf or we're just not equipped to fight it.

You really have to become an amateur lawyer and present this as a legal case or throw a dart and hope your VSO does it well for you. You can read cases that seem to be pretty convincing for the veteran yet they are denied or lowballed for not dotting i's and crossing t's.

I recommend listing each ailment and researching exactly how the VA compensates for it and don't forget to include possible side effects from prescribed medications.

An excellent resource for both VA and SSDI is member fanaticbooks' site http://www.howtoassemblevaclaims.com/

Good luck!

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.
LC

thankd Megp Im going to take a closer look at my med recs and see exactly what is notated.

the VA can put whatever spin they want on it but here are the facts/
Sleep disturbances are presumptive for GWI.;
A medical doctor employed by the va, diagnosed me with a SLEEP DISTURBANCE called SLEEP APNEA.
ITS all there in black and white.
YET the va denied me compensation and says under thier " criteria " it isnt presumptive.
A 5 year old child can understand what is going on here.
Same way with scars. VA terminology to deny calls scars SUPERFICIAL. If you look up how scars are described in the =medical community, theres 3 definitons of types of scars, and superficial is not used to describe a scar. vs uses wordplay to downplay severity of injuries or ilnesses. how can a scar be superficial? you cannot have a scar above the skin.. it would be in thin air. If there is a scar, it must be in one or more layers of the skin. When I had my kidney operation they cut thru all 3 layers of skin, thru layers of muscle thru layers of fat, until they opened my abdominal cavity. YOU CANT GO NO DEEPER .!!! the scar is 13 inches long and 1/4 inch wide.
The cp examiner claims it was 0.01 mm long and SUPERFICIAL// you see what they do? that was no mistake. they look in detail for any angle to use to deny you. you must remain vigilant. READ YOUR MEDICAL RECORDS, READ YOUR CP EXAMS, READ YOUR DENIAL LETTERS VERY CLOSELY. look at each sentence as a stand alone statement. does it hold water?. the reason I say read each sentence as a stand alone statement is ive studies how the va writes paragraphs to deny. each sentence is usually very bland with little detail, and they do several of these, but at the end of the paragraph, they will quote a very specific law or regulation, to tie those very bland sentences to to try and convince you that the ALMIGHTY LAW has been spoken and it applies specifically to you, and you are wrong and they are right. BREAK IT DOWN. everything they state must be completely accurate, or you can challenge it.

Welcome, Cody!

Carlie is right- the traditional route (advised by VSO's etc) was to file your claim immediately to 'preserve the date" and then send evidence later; this could cost you months/years versus doing the research and filing a complete claim with solid evidence.

And feel free to vent whenever you need it - this IS the place for that (with a few rules )

Welcome, Dee!

None of us knew we'd need to become lawyers to win in a System we thought cared about us, so denials are the norm.

I recommend medicare docs for your care.

We can be most helpful if you post the exact reasons for denials (deleting any personally identifiable info).

Learn all you can to make strong case for your ailments and file again!

https://www.navyfederal.org/index.php

Navy Federal Credit Union is an excellent bank. It is available to ALL military, not just Navy. We signed up with them recently & applied for a credit card. We have crappy credit, yet received a $5,000 credit limit. They also do low interest mortgage loans, low interest car loans and personal lines of credit.

You can use any local credit union as an ATM and they will waive any fees. You can speak with them by phone or email. It only takes $100 to get started with the free savings and checking account.

They are good. I've been with them since 1979, and I have never had a problem with them.

They generally take everything under consideration and then decide if it's service connected and how bad it is. They generally lowball on the rate they allow ya. PTSD is rated under code 9411. Look up 38 CFR 4.130 to see the ratings for PTSD. PTSD is rated at 100%, 70%, 50%, 30%, 10% or 0%, depending on how bad the PTSD affects/effects your daily life, and not how bad the stressor was that caused the PTSD. You can look at the descriptions of each rating and figure out where you should be. If they don't rate you properly you can appeal their decision. They started me at 30%, in 1989, and in just over 10yrs, later, 1999, I was awarded 100% back to day one of my claim.

pr

You might find some cases that are similar by searching for 38 CFR 3.157 (If you search for earlier effective date you will come up with tons of TDIU claims). The claims might not be exactly like yours, but you can begin to get a pattern of the cases that were denied and granted - and the reasoning. Also, look for the cases cited in the reasoning, and use those cases as a search term to search some more.

I am not even sure that you would have to show the RO "at fault" on this - for not adjudicating the claim earlier. But you very well might start building a case that an earlier VA exam showed that your husband's seizures had increased (even if the doctor didn't specifically use that word), and thus, the increased rating should be granted from the time of that VA exam.

I love your spirit NOD. There is an ancient chinese saying that basically translated to this..
A LION CANNOT KILL ELEPHANT IN ONE DAY. BUT IF THE LION BITES THE ELEPHANT ONCE A DAY. HE CAN KILL AN ELEPHANT IN A WEEK.
This is the mentality you must have when battling an entity that is much larger., and powerful than you are. little victories, till they tire and retreat.

Start scheduling appointments ASAP. You can start with your general doc. They will ask you questions every time you do your triage intake on your appointments about your general mood, suicidal thoughts, etc. Make sure you are telling your doc about all your feelings and stress that you would like to get involved in PTSD counseling because of them. Make sure you're relating these things to the combat tours you were in and nothing prior to that. Talk about the things you saw and what those dreams are about. That will get the ball rolling. That initial exam just gets you in the door and is nothing to worry about. Just hoops to jump through. But you'll need to stay in the system and keep making appointments. You'll need to enroll in ebenefits and myhealthevet, too. Ebenefits will have where you apply for compensation. You can always talk to a vet rep to help you through the process before you do so. Any injuries, wounds, surgeries, etc you should apply for, even if you get a 0 rating it's still on the books to get you started with any future complications.

Here are links to both sites to get you started there:

https://www.ebenefits.va.gov/ebenefits-portal/ebenefits.portal?_nfpb=true&_nfxr=false&_pageLabel=Apply

https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome