spike

I apologize for my long absence. It happens when people are very busy. Here is the take that the VAMC's are going to tell you. However, the facts are this. Your clothing allowance has to go in. The prostetics departments are going to have to get Central Office guidance. If you received a denial by a person at the VAMC, that is because they do not have the knowledge background on the case. The Central Office will have to rule. I do not believe it will be a matter of an appeal at the VBA. I believe it will be a matter of reconsideration once the Central office gives guidance. I would wait until the middle or end of August. Here is the thing everyone. This case went ABOVE the BVA...it is a Federal Circuit Court decision. The VA already lost their case for denial. The ONLY way this decision can be overturned is in the US Court of Appeals. This is not up to the CAVC.

Apply...Sorry I've been busy and away at conferences, meetings and stuff sorry for the long delay

nice post Berta...thanks

Fletch, I am going to help you out a little more in regards to this and provide you with something I think is important for everyone to know...but it relates to you here because you have several questions and it sounds like your navigating through the VA system.... There are 7 ways to be Service Connected: 1. Direct 2. Aggervated 3. Paired Organ 4. Vocational Rehab 5. Hospital Care 6. Presumptive 7. Secondary You are SC now....from 10 years from SC date VA can not take away your Service Connection. However, disabilities are more likely than not to get worse and not better, your able to put in for an increase. In order to get your SC you were able to prove the following requirements: 1. (AN INJURY) You had an injury in military service (or one followinging if the above), a disease that began in or was made worse during military service or there was an event in service that caused an injury or disease and; 2. (A DIAGNOSIS aka MEDICAL OPINION)You have a current physical or mental disability shown by medical evidence (diagnosis and/or treatment records) and; 3. (A CONNECTION BETWEEN #1 AND #2) There is a relationship between your disability and an injury, disease or event in military service. Medical records or medical opinions were required to establish this relationship (or lay statements, buddy statements, etc). However, under certain circumstances the VA has in the past and may conclude that certain disabilities were caused by service even if there is no specific evidence proving this in your particular claim (presumptive). This cause of disability is presumed for the certain veterans eras (i.e. Vietnam, Persian Gulf, POWs,and many others). What you need now is to build a case of how your disabilities have gotten worse or become more frequent or how they have affected you more. If they haven't great. If they have take a look at the two Regulations one is USC (United States Code) Title 38 and CFR (Code of Federal Regulations) Title 38 Part 4 Adjudication Schedule for rating disabilities.... Oh by the Way Marine.....Semper Fi .....

Jbasser, I showed him how to understand how they come up with the percentages, and the calculator is an amazing tool....(however we have to work on getting it a box to check of for bilateral factor)......and what I was getting at with fletch was if he is SC at 0% thats half the battle won.....you can get an increase but proving SC is a major part of the rating process..

Your SC 0% Right?

for example this is how the combined rating schedule gets you 4 ratings at 50% and only gets you 94% and when it rounds down you get 90% unless you apply for I/U.....(unless you count any bilateral factors but here goes the explanation if you take a whole 100% and you take a 50% away you get= 50% so now you have 50% ability now your at 50% and 50% of that is 25 so add that to the 50 and you get 75% for those who are keeping track that is 2 ratings at 50%= 75% combined take 75% and now you have a remaining 25% of functional health.... what is 50% of that remaining 25%= 12.5 that gives you 88% so now you have three ratings at 50% right? like I said not considering any bilateral factors......what is 50% of the remaining 12.5% of functional ability 6.25 add that to 88% and you get 94.25=rounded down to the nearest whole number= 94% rating. However when they give you your rating letter they will say you are 90% SC not 94%.....but if you were to file a claim they would go from that percentage......94. I am not saying I agree with the math. However, I have said it before, I go through training and conferences, and ask questions to the outlets/resources available to me. Now oddly enough, I can do this in my head without looking at the combined rating schedule until we start going into SMC and it doe make it slightly harder when we consider bilateral factors......but thats the VA Math explained So thats how they get the 4 50's don't equal 200% not 100%....ratings in themselves have been scrutinized by many as not evaluating the veteran as a whole but by its parts.....both in the VARO and VAMC....

shouldnt this be under percoset refill post topic john??

John What I am very surprised at is that your pharmacist manager wasn't willing to give you 5 day supply until the refill would be resupplied. Next time that happens, I would request to see the Director or the AOD (Administrator on Duty). Be Calm and be nice.... so you don't get a BERT Alert called on you......(I've heard them called over the PA System before) if you didn't know what that is BERT stands for B.ehavioral E.mergency R.esponse T.eam .....aka BERT Alert....Usually a Psych Doc, a social worker, police officers, an administrator, ER Team Member, etc.

Fact Sheet 16-1 January 2009 2009 Copay Rates Effective January 1, 2009 Outpatient Services * Basic Care Services services provided by a primary care clinician $15 / visit Specialty Care Services services provided by a clinical specialist such as surgeon, radiologist, audiologist, optometrist, cardiologist, and specialty tests such as magnetic resonance imagery (MRI), computerized axial tomography (CAT) scan, and nuclear medicine studies $50 / visit * Copay amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copay amount is based on the highest level of service received. There is no copay requirement for preventive care services such as screenings and immunizations. Medications For each 30-day or less supply of medication for treatment of nonservice-connected condition $8 (Veterans in Priority Groups 2 through 6 are limited to $960 annual cap) Inpatient Services ** Inpatient Copay for first 90 days of care during a 365-day period $1,068 Inpatient Copay for each additional 90 days of care during a 365-day period $534 Per Diem Charge $10 / day ** Based on geographically-based means testing, lower income veterans who live in high-cost areas may qualify for a reduction of 80% of inpatient copay charges. Long-Term Care *** Nursing Home Care/Inpatient Respite Care/Geriatric Evaluation maximum of $97/day Adult Day Health Care/Outpatient Geriatric Evaluation Outpatient Respite Care maximum of $15/day Domiciliary Care maximum of $5 / day *** Copays for Long-Term Care services start on the 22nd day of care during any 12-month period—there is no copay requirement for the first 21 days. Actual copay charges will vary from veteran to veteran depending upon financial information submitted on VA Form 10-10EC.

John, I just had to do this...please forgive me....but I am a Marine....so I just had to.... John...you have a pet rock????? Sometimes, I hear vets vent to me and they say that the VA never heard a darn thing that meant anything they were suppose to hear.....the important stuff.....but they heard the stuff that was meaningless.....and they focus on it....just like I did...... But, um John you have a pet rock??? Again the VA sometimes has a 5 second memory....oops, I've been hanging out with these guys too long...ok I'll post a more meaningful post.... I once had a veteran tell me that his doctor was out.....so the OEF/OIF counselor told him to go to the ER and he was calling down to the ER to explain....when the veteran got down to the ER the nurse who greeted the OEF/OIF Veteran said word for word this "You better have a damn good reason for coming".....Vet then asked "Say again" not thinking she would repeat and the Nurse then said again "You better have a damn good reason for coming down for this instead of waiting for your doctor to return (it was a holiday weekend in the same situation as you John) he made a complaint to the Director and a meeting was made for the supervisors/managers and an apology was made and it was made record....to my knowledge

Ok...I am not a moderator but try to keep your postings/topics together if they are indeed the same subject...making multiple topics on the board about the same issue can lead to confusion and possibly someone not getting the full picture... Hope the advice helped.

Mike, Looking at your profile I see that your last date of service was in 1993....that wouldn't qualify for the eligibility for Wounded Warrior Status which is have to have served during or after 9/11/01

Under the Wounded Warriors provision...I would suppose they automatically put you in the category.... http://www.ssa.gov/woundedwarriors/

Ok, I after reading the thread....I think I am sure what is going on here.... If you are not over the 50% SC disability....anything you are treated for that is not a SC disability can have co pays to include your medications. In addition to include more confusion on this issue....let's say your being treated for example PTSD....but it is not SC and during the whole time they are making a decision on your SC at the Rating Board, your treatment, medical co pays and co pays for medicine add up.....if they start a collection or you paid those co-pays....and you become SC your entitled to a refund of the co pays. SOME VA's are good and put the co pays in suspense but rely heavily on the veterans to tell them they applied for SC....you can find that person in eligibility in your Veteran Service Center at the VAMC. A means test is also done if you apply for financial hardship. In order to waive the co pays to help relieve you of some costs, they ask you to do a means test...to make sure you have the means to pay. NSC pension is for low income. However, if you are receiving income, you are best advised to cease the payments of the NSC Pension. NSC pension is offset by the income you make.....SSD and SC Disability is considered income in this sense. YOU WILL OCCUR A overpayment and I've I've seen/heard overpayments in the amounts of over 50k range.....no waiver request usually gets you out of this jam because it says specifically that you are to report all income........when making application....

This court decision was made outside the CAVC it was made in the US Court of Appeals Federal Circuit. It was denied at the CAVC. If I remember correctly the fees were small. Sursely is a double amputee who was the former National Commander of the DAV years ago, just in case that name sounds familiar.....

Being rated at the 100% rate due to being hospitalized for surgeries or the like is basically a temporary increase to subsidize the loss of income due to the fact that you are being hospitalized and unable to work during which time your having surgery and recovering. But here you go as per the reg(s). However, when you are no longer hospitalized and per your recovery you would fall under this statement in the regulations below...... When the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section. It sounds like the VA found that the evidence was adequate to assign a schedular evaluation, so while a physical examination was scheduled it was not needed to terminate the total rating. If this helps good, if not let me know...but this SOUNDS like your case...but I am not sure....and I've had a long week so I am exhausted and might be missing something.....

Jim Mac, Were you hospitalized for any period of time when you obtained your 100% because it sounds to me you were rated under 38 CFR 4.30 Convalescent Ratings but more specfically your 6 months sounds like subsection b. #2 of this section....but I am not sure with the information you provided or if it falls under 4.29 Ratings for service connected disabilities requiring hospital treatment or observation...... I've put both here (however if this is the case I would still apply for the I/U let me know if you want that regulation as well.... § 4.29 Ratings for service-connected disabilities requiring hospital treatment or observation. A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a Department of Veterans Affairs or an approved hospital for a period in excess of 21 days or hospital observation at Department of Veterans Affairs expense for a service-connected disability for a period in excess of 21 days. (a) Subject to the provisions of paragraphs (d), (e), and (f) of this section this increased rating will be effective the first day of continuous hospitalization and will be terminated effective the last day of the month of hospital discharge (regular discharge or release to non-bed care) or effective the last day of the month of termination of treatment or observation for the service-connected disability. A temporary release which is approved by an attending Department of Veterans Affairs physician as part of the treatment plan will not be considered an absence. (1) An authorized absence in excess of 4 days which begins during the first 21 days of hospitalization will be regarded as the equivalent of hospital discharge effective the first day of such authorized absence. An authorized absence of 4 days or less which results in a total of more than 8 days of authorized absence during the first 21 days of hospitalization will be regarded as the equivalent of hospital discharge effective the ninth day of authorized absence. (2) Following a period of hospitalization in excess of 21 days, an authorized absence in excess of 14 days or a third consecutive authorized absence of 14 days will be regarded as the equivalent of hospital discharge and will interrupt hospitalization effective on the last day of the month in which either the authorized absence in excess of 14 days or the third 14 day period begins, except where there is a finding that convalescence is required as provided by paragraph (e) or (f) of this section. The termination of these total ratings will not be subject to §3.105(e) of this chapter. (;) Notwithstanding that hospital admission was for disability not connected with service, if during such hospitalization, hospital treatment for a service-connected disability is instituted and continued for a period in excess of 21 days, the increase to a total rating will be granted from the first day of such treatment. If service connection for the disability under treatment is granted after hospital admission, the rating will be from the first day of hospitalization if otherwise in order. © The assignment of a total disability rating on the basis of hospital treatment or observation will not preclude the assignment of a total disability rating otherwise in order under other provisions of the rating schedule, and consideration will be given to the propriety of such a rating in all instances and to the propriety of its continuance after discharge. Particular attention, with a view to proper rating under the rating schedule, is to be given to the claims of veterans discharged from hospital, regardless of length of hospitalization, with indications on the final summary of expected confinement to bed or house, or to inability to work with requirement of frequent care of physician or nurse at home. (d) On these total ratings Department of Veterans Affairs regulations governing effective dates for increased benefits will control. (e) The total hospital rating if convalescence is required may be continued for periods of 1, 2, or 3 months in addition to the period provided in paragraph (a) of this section. (f) Extension of periods of 1, 2 or 3 months beyond the initial 3 months may be made upon approval of the Veterans Service Center Manager. (g) Meritorious claims of veterans who are discharged from the hospital with less than the required number of days but need post-hospital care and a prolonged period of convalescence will be referred to the Director, Compensation and Pension Service, under §3.321(:P(1) of this chapter. § 4.30 Convalescent ratings. A total disability rating (100 percent) will be assigned without regard to other provisions of the rating schedule when it is established by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release that entitlement is warranted under paragraph (a) (1), (2) or (3) of this section effective the date of hospital admission or outpatient treatment and continuing for a period of 1, 2, or 3 months from the first day of the month following such hospital discharge or outpatient release. The termination of these total ratings will not be subject to §3.105(e) of this chapter. Such total rating will be followed by appropriate schedular evaluations. When the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section. (a) Total ratings will be assigned under this section if treatment of a service-connected disability resulted in: (1) Surgery necessitating at least one month of convalescence (Effective as to outpatient surgery March 1, 1989.) (2) Surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited). (Effective as to outpatient surgery March 1, 1989.) (3) Immobilization by cast, without surgery, of one major joint or more. (Effective as to outpatient treatment March 10, 1976.) A reduction in the total rating will not be subject to §3.105(e) of this chapter. The total rating will be followed by an open rating reflecting the appropriate schedular evaluation; where the evidence is inadequate to assign the schedular evaluation, a physcial examination will be scheduled prior to the end of the total rating period. ( A total rating under this section will require full justification on the rating sheet and may be extended as follows: (1) Extensions of 1, 2 or 3 months beyond the initial 3 months may be made under paragraph (a) (1), (2) or (3) of this section. (2) Extensions of 1 or more months up to 6 months beyond the initial 6 months period may be made under paragraph (a) (2) or (3) of this section upon approval of the Veterans Service Center Manager.

Just so I am clear is this part of the other post....."What do you make of this....VSO Withdrawl", am I looking at the same situation? I responded to one, but wondering if this is Part II of the previous Post or if this should be part of the same post situation..not that I am anyone but I am trying to follow....they are from the same thread starter, both have VSO withdrawl...both have DRO Hearing....someone please advise?

Nicely done.

If you look at the bottom of the 21-22 you will see the following statement: "I, the claimant named in Items 1 or 7, hereby appoint the service organization named in Item 3 as my representative to prepare, present and prosecute my claim for any and all benefits from the Department of Veterans Affairs based on the service of the veteran named in Item 1. I authorize the Department of Veterans Affairs to release any and all of my records (other than as provided in Items 13 and 14) to that service organization appointed as my representative. It is understood that no fee or compensation of whatsoever nature will be charged me for service rendered pursuant to this power of attorney. I understand that the service organization I have appointed as my representative may revoke this power of attorney at any time, subject to 38 C.F.R. 20.608. Signed and accepted subject to the foregoing conditions." According to 38 CFR Part 20 Rule 20 Here is the regulation on that.......... Title 38: Pensions, Bonuses, and Veterans' Relief PART 20—BOARD OF VETERANS' APPEALS: RULES OF PRACTICE Subpart G—Representation Browse Previous | Browse Next § 20.608 Rule 608. Withdrawal of services by a representative. (a) Withdrawal of services prior to certification of an appeal. A representative may withdraw services as representative in an appeal at any time prior to certification of the appeal to the Board of Veterans' Appeals by the agency of original jurisdiction by complying with the requirements of §14.631 of this chapter. (;) Withdrawal of services after certification of an appeal —(1) Applicability. The restrictions on a representative's right to withdraw contained in this paragraph apply only to those cases in which the representative has previously agreed to act as representative in an appeal. In addition to express agreement, orally or in writing, such agreement shall be presumed if the representative makes an appearance in the case by acting on an appellant's behalf before the Board in any way after the appellant has designated the representative as such as provided in §§20.602 through 20.605 of this part. The preceding sentence notwithstanding, an appearance in an appeal solely to notify the Board that a designation of representation has not been accepted will not be presumed to constitute such consent. (2) Procedures. After the agency of original jurisdiction has certified an appeal to the Board of Veterans' Appeals, a representative may not withdraw services as representative in the appeal unless good cause is shown on motion. Good cause for such purposes is the extended illness or incapacitation of an agent admitted to practice before the Department of Veterans Affairs, an attorney-at-law, or other individual representative; failure of the appellant to cooperate with proper preparation and presentation of the appeal; or other factors which make the continuation of representation impossible, impractical, or unethical. Such motions must be in writing and must include the name of the veteran, the name of the claimant or appellant if other than the veteran (e.g., a veteran's survivor, a guardian, or a fiduciary appointed to receive VA benefits on an individual's behalf), the applicable Department of Veterans Affairs file number, and the reason why withdrawal should be permitted, and a signed statement certifying that a copy of the motion was sent by first-class mail, postage prepaid, to the appellant, setting forth the address to which the copy was mailed. Such motions should not contain information which would violate privileged communications or which would otherwise be unethical to reveal. Such motions must be filed at the following address: Office of the Senior Deputy Vice Chairman (012), Board of Veterans' Appeals, 810 Vermont Avenue, NW., Washington, DC 20420. The appellant may file a response to the motion with the Board at the same address not later than 30 days following receipt of the copy of the motion and must include a signed statement certifying that a copy of the response was sent by first-class mail, postage prepaid, to the representative, setting forth the address to which the copy was mailed. (Authority: 38 U.S.C. 5901–5904, 7105(a)) (Approved by the Office of Management and Budget under control number 2900–0085) Short version: VSO's can revoke for Good Cause....which is here "Good cause for such purposes is the extended illness or incapacitation of an agent admitted to practice before the Department of Veterans Affairs, an attorney-at-law, or other individual representative; failure of the appellant to cooperate with proper preparation and presentation of the appeal; or other factors which make the continuation of representation impossible, impractical, or unethical." Any Service Organization can revoke a POA for things that fall within these realms. Also a POA will be revoked when you change from one service organization representative to another.......and the VA does that and that has nothing to do with your previous Service Organization...the VA only enters one service organization at a time..... Does this help???? VA_Form_21_22.pdf

United States Code Title 10 Armed Forces Here is the link. http://uscode.house.gov/download/title_10.shtml US Code Governing the Armed forces Need more information, advice let me know.....

deltaj, Very good question/statement. However, let me explain. This decision was denied even at the VA Court of Appeals. If you look at the top of the original post you will see that it indicates "United States Court of Appeals for the Federal Circuit". This means that Sursely decided to take the case 1 step further and outside the the Court of Veteran Appeals....he brought it to the US Court. When you do this you have brought it outside the scope of VA and you would have to pay the court fees as any other citizen would have to. This needs to be said as well. The only way that they can change this decision is obtain a favorable decision from the US Supreme Court. Which in the meantime, I am sure veteran organizations will argue against that change. Hope this clears things up. Many of the VA Hospitals Prostetics Department Directors may be waiting for a directive before uttering a word about this case. Since I keep up to date on case laws, I posted it as soon as the decision was made for Hadit members to have immediately....got to love the internet..... ;)

Four Ways to expedite a claim for Hardship.... 1. Proof of financial hardship (extreme cases) 2. Age 70+ 3. Terminal Illness 4. Homeless

Here is what I see in what you just quoted to me. M21-1 basis statements = appeal = years at AMC/BVA. I'd rather take the time to help a vet build a solid case on the basis of LAW, instead of being "Against the Wall" with a weak case and quote everything I can find to include the M21-1 and anything else I can find with the VA logo on it. Building a solid case may take a few weeks, maybe even a month....but to get a solid bonafide rating based on the evidence and law, saving the vet years of waiting for an appeal to come back based on M21-1 Procedure manuals is what I think most vets would rather see, I know I would (wouldn't you?)....In fact I'd fight a denial at the local and national level all day long if I knew I had it based on the CFR and USC with solid evidence....I would be concernded if I basised it on M21-1, and just me personally I think I would feel like I wasn't doing my absolute very best for the veteran if I based their case on a Procedure Manual instead of Law. I know this hurts, but I am only here to help.... Friends , wings?