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About NoTheEnemy

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    E-3 Seaman

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  • Service Connected Disability
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  1. If I'm not mistaken, I don't believe any RO's actually keep physical C-files. I haven't seen one in a few years. Everything goes to an intake site and is digitally scanned. Have you tried contacting the RMC?
  2. Berta, First I want to thank you and your late husband for your service. I truly am sorry for the continued difficulty you're having with your RO and pray you get fair decisions. After writing that, I realize I sound like some customer service rep that is required to spit that out whenever they receive a complaint. But it really burns me up when I hear stories like this. I'm a veteran myself and it sickens me to know that I am part of an organization with these kinds of people. It also hurts a lot of times when I get lumped into the same category as these people simply because I have the same title as they do. I can't tell you how many times I've literally been threatened because a disgruntled veteran found out what I did for a living. The latest being from my mechanic " You work where?! I should castrate you right here on this shop floor." In fact, the first response I got from you after I introduced myself and expressed my willingness to help the folks on this forum was a semi-passive aggressive remark insinuating that I was wasting time posting here and not working veteran's claims. If I'm taking that the wrong way, I sincerely apologize. I brought that up to say this: No system is perfect, there are bad employees in every organization. These employees should be, and under the new administration, likely be terminated. DC has taken the first steps in making it easier to accomplish this. There are also things in the works happening at RO's on a local level that you may or may not be privy to. As a federal employee, these solutions will have little affect on me because I do what I'm supposed to do and maintain my job performance at an exceptional level. As a veteran, some of these solutions concern me and I'm afraid of unintended consequences (more contracted exams, longer wait times for those exams, decreased funding for outreach programs to pay the contractors, increased time for claim completion due to fewer employees etc.) You mentioned that you can't wait for the VA to change and that you will make sure you change the claims process. The claims process has evolved exponentially in the past few years and will continue to do so. VA has made it easier for veteran's to file a claim, have relaxed standards for multiple conditions and you don't even have to use a VA doctor for your C&P exam for the majority of conditions. How would you change the claims process outside of what VA is currently progressively doing? Other than the appeals process, I believe VA is making tremendous strides in making the process more streamlined and efficient. It is not perfect and no where near where we want it to be, but there is progress. I have been rating claims for going on 9 years now. You would think that with 9 years of experience, I would be able to know the process like the back of my hand. I don't, because of the constant change and evolution of the claims process. I'm sure you're familiar with the M21-1MR, 38CFR chapters 3&4, the publications, the fast letters, the training letters the court precedents etc etc... Who on earth could memorize all of that and go an entire career without making one mistake. Especially since all of those are updated at least once a month with some new law or directive that we have to remember to apply immediately after being notified of it. We are constantly in training classes where the gist is "ok, we've been told to do it this way for years but they just changed it yesterday. Here is a power point presentation about it, now go out and be perfect" I realize that I've been ranting (gross understatement) and that was not my intention at the beginning of this post. Based on the information in your response, you have a right to be angry and distrusting of the VA system. I truly do not blame you one bit. However, despite what you may think based on your experiences and what you've encountered on this forum and other platforms and such, your situation is the exception and not the rule and that's the vibe I get from many of your posts that your situations are the standard. Out of millions of claims filed and thousands of employees, there will be those bad apples that give VA a bad reputation because that is what you will hear on the news and on this forum and other outlets. I'm not saying it isn't true, its just all that we hear. What you will rarely see are the millions of veterans that are happy with their experience with VA. Myself, along with dozens of co-workers have received personal letters from veteran's thanking us for the service that we provided to them. If a tree falls in the forest and no one is around, does it make a sound? Not if that tree is a model employee working at the Department of Veteran Affiars.
  3. Andyman73, please accept my sympathies for the situation you had to go through. And please know that VA has a ton of resources and programs that will hopefully help ease this pain as time goes on. Definition of MST per Title 38 U.S. Code 1720 D : Psychological trauma resulting from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training.” Sexual harassment is defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.” There is no indication that both victim and perpetrator must be military, only that the assault, battery or harassment must occur while the victim was serving on active duty, active duty for training or inactive duty training. Question: You mentioned regular therapy sessions. I notice on your profile that you are currently service connected at 80%. Would you happen to be service connected for any psychological conditions? The reason I ask is because VA does not service connect "MST" as a condition, rather, we service connect the residual psychological conditions that were caused by the MST. And since VA does not give separate evaluations for any psychological conditions, if you currently have a service connected psychological condition, we would treat your claim as an increase (while also providing all the resources for MST victims and examining the entire record for evidence that the event may have occured). There wouldn't be a separate rating for MST, it would get added onto the other psychological condition (assuming the MST was conceded). If this doesn't apply to you, then disregard this entire paragraph Evidence that can help support a claim for MST: Any DOD form that is used to report incidences of sexual assault/harassment, and investigative reports. (these don't seem to apply to your case) "Markers" Markers are things like seeking counseling, pregnancy tests/STD test requests at sick call, statements from roommates, family, clergy members and fellow service members, transfer requests, work performance deterioration, substance abuse, episodes of depression/anxiety/panic attacks with no identifiable cause, economic and social behavioral changes, relationship issues/divorce, sexual dysfunction. "Markers" are not limited to this list.
  4. My recommendation is to wait. But that's just based on the information I have. Its in the final stages. If you start sending stuff in before it is adjudicated (additional evidence, duplicate evidence etc..) it could delay your claim. Sometimes the system auto generates a claim status, when in fact, the claim is much further along. The system sometimes has hiccups. I've been assigned claims to work before that say RFD (ready for decision), I quickly glance over it to see what i'm dealing with and notice that the entire claim is rated, the award has been processed and the veteran has been notified and probably received their first payment. I'm honestly not sure why it would keep going back and forth. That is part of the process before it gets to my desk and I'm not confident enough to give an opinion other than the known occasional hiccups. "Preparation for decision"...I"m going to assume this means "Ready for decision" I'm not sure if Ebenefits and the system at the RO use the same terminology, but when a claim is RFD, that means its in a queue waiting in line for a rater to work it. I'm not sure what the suspended letter is, but we do have a term we use, "suspense" which basically tells us when the claim should be moved on to the next step. If nothing happens in the system that automatically closes that suspense, then there will be an "alert" for us to check up on it. For example: Claim is sent ready for decision with a suspense date of 2/14/17. 2/15/17 arrives and it hasn't been rated. The system sends an alert (hey, this claim was supposed to be moved on in the process by this date, what gives?) We see that somehow it slipped through the cracks and it is put on a priority list. However, if someone does work it before that suspense date, it automatically closes that date and creates another for the next step in the process (the majority of the time). When was your claim filed? Is it an original claim?
  5. I'm going to assume that you mean you filed an informal claim (VA Form 21-0966 Intent to file) on 12/11/2015, sent the paperwork to the VSO on 12/7/2016 but the VA received the completed claim on or after 12/12/2016? What do you mean by "canceled old claim"? If the previous statement of mine above is correct, then VA won't "cancel" your claim. We can't withdraw a claim unless the veteran or POA instructs us to. And as a matter of fact, a submission of Form 21-0966 isn't even a claim. Its basically used to lock in an effective date (date VA received 21-0966) for up to one year. If we receive the formal claim (526 EZ) after a year, then we simply use the date we received the formal claim as the effective date (assuming this is an original claim). I have never heard of a waiver to reinstate the date of the 21-0966 as the effective date after the 1 yr expiration date has passed
  6. I don't have my resources in front of me right now, but if I remember correctly, SMC housebound requires one disability individually rated at 100% along with one or more separate service connected disabilities (not a combination of NSC and SC) that would equal 60% combined. If you did not specifically claim SMC at the housebound rate and we see that you don't qualify, then VA does not have to infer it as an issue. VA does not infer an unclaimed issue on a rating knowing we could not grant it based on all available evidence at the time. Example 1: Vet is XX% disabled, files an increase for one condition and we grant that specific issue with an increase to 100%. He has other SC disabilities that do not equal 60% combined and there is no evidence that the veteran is housebound "in fact". VA does not have to raise the issue for SMC housebound because he does not meet any of the criteria. Example 2: Vet is XX% disabled, files an increase for one condition along with an application for SMC at the housebound rate and we grant that specific issue with an increase to 100%. He has other SC disabilities that do not equal 60% combined and there is no evidence that the veteran is housebound "in fact". VA DOES have to provide a rating decision indicating a denial because the criteria were not met and the vet specifically claimed SMC housebound. What it looks like the RO did was see that you were not eligible for SMC housebound but you are eligible for SMP housebound should you ever decide to switch to pension instead of compensation payments.
  7. As I've stated, my knowledge is extremely limited when it comes to pension claims. Here is how I see it, correct me if I'm wrong. You were granted housebound status because you have a single 100% rated disability along with other service connected (compensation) AND non-service connected (pension) disabilities rated at 60% combined. Since the combined 60% contains sc and non-sc conditions, VA can't grant SMC. If the housebound grant falls under pension then I don't see why VA would be able to pay that money along with compensation payment when compensation and pension can't be awarded at the same time. SMC and SMP have different eligibility requirements and pay schedules. Housebound under SMC is paid in addition to compensation and Housebound under SMP is paid in addition to pension. They have to award the grant because at anytime, you can elect to receive the pension payments instead of the compensation payments even if it reduces the amount of money you receive
  8. You're more than welcome. I absolutely advise getting a diagnosis for your knee pain, and especially do it while on drill or when called to active duty again. Make sure you get copies of your medical records from the Reserve/NG unit, as these can sometimes be difficult to find after discharge. There are guidelines for presumptive/chronic status for undiagnosed illnesses and medically unexplained chronic multi-symptom illnesses that are afforded to veteran's that served in the Southwest Asia Theater of operations. However, Afghanistan is not included in VA's definition of the Southwest Asia Theater of Operations, which I truly don't understand. There are 9 rare, infections disease that are considered presumptive for veterans who've served in Afghanistan.
  9. Here is how I would look at that claim: Since there is documented evidence of an event (fell on frozen ground) that VA concedes was the cause of your service connected TBI, I would ask for direct service connection and request a medical opinion asking if your current cervical spine condition was caused by the event in service. It seems unlikely that we could service connect a cervical spine condition as secondary to residuals of a brain injury. However, if you did decide to claim it secondary, VA will first attempt to service connect direct. If we can't, that's when we'll go with secondary service connection.
  10. from 38 CFR 4.114 Schedule of ratings -Digestive system 20% Small, not well supported by belt under ordinary conditions, OR healed ventral hernia or post-operative wounds with weakening of abdominal wall AND indication for a supporting belt. 0% Wounds, postoperative, healed, no disability, belt not indicated My interpretation is that the belt is required because if you look at the 0% criteria, it shows that if a belt is not indicated then it only warrants a zero. I would ask myself..."Is a belt indicated? If yes, do either one of the criteria for the next higher percentage apply? If no, then the condition is rated at 0% Also, the supporting belt alone would not warrant a 20% evaluation. Evidence has to show a healed ventral hernia or post-operative wounds with weakening of abdominal wall as well. The veteran in that hearing could have been awarded the benefit based on "not well supported by belt under ordinary conditions" and therefore didn't wear one because it didn't offer support anyway. I hope this helps.
  11. Ok, so I read the question thoroughly and understand that this is a grant for special monthly pension where payment has not been awarded. Unfortunately, I have zero experience with pension claims as these are only done at the Pension Management Centers that have specific service areas (Philly RO, Milwaukee Pension center and St. Paul RO). The extent of my knowledge on pension claims is that I know what they are and where to send the claim if one comes to me by mistake. My advice is to call the 800-827-1000 number for issues regarding missing payments. I apologize for not being to help further.
  12. Funny you ask this question today...I'm actually in refresher training right now for "Higher Level SMC" I briefly skimmed through this question and am just sending this brief response because I'm on break from training and just checking responses. Plus, I'm on my phone. Apparently, Higher level SMC is a national error trend and I understand why. SMC calculations are very difficult to master. sorry for the non-response but I'm limited on time right now. I'll get back to you by the end of the day, hopefully by lunch time.
  13. I know that to get 50% for sleep apnea with c-pap, we don't have to have evidence of a prescribed c-pap machine The exam only has to state that a c-pap would benefit the veteran (paraphrasing). So, the same could be true for the language for 7339. I'll ask around in the morning at work, do some research and get a definitive answer for you
  14. Thanks, I'm happy to be here and ready for the challenge :-)
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