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About pointer123

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    E-2 Recruit
  1. I am a retired Marine infantry Officer and have been rated for tinnitus at 10% and hearing loss at 0% since 1997 when I retired. My hearing got consistently worse over the years . In June 2017, I decided to claim additional disabilities related to arthritis, my eyes (diplopia), vertigo, an increase in my hearing loss, and TDIU. I was a Marine parachutist and scuba diver and was diagnosed with left ankle arthritis via x-ray in 1981. Because I was diagnosed with this chronic disease while in service, I think this should be supportive of my existing arthritis claims. I currently have x-ray documentation of arthritis in virtually every joint. However, I want to focus on the increase in hearing loss aspect of my claim. They rated my June 1997 claim in March 2018 and gave me a combined 80%. Relative to hearing loss and tinnitus, I got a VA half-baked hearing exam at a VA C&P exam which continued my hearing loss at 0%. All the audiologist performed was, in my opinion, a biased air conduction test and speech discrimination test. I was previously rated at 50% combined in 1997. The new award from the June 2017 claim gave me 10% arthritis in my left knee and 10% arthritis left ankle and 10% arthritis right knee. They service-connected left and right calf soleus muscle tendonitus as part of each of the knee 10% arthritis ratings (I contend that the muscle tendonitis should have been rated separately). They also gave me 30% for aphakia of left eye (instead of uncorrectable bilateral diplopia as it should have been). This left me with 80% combined. Within this rating they failed to rate (omitted) - my vertigo disability claim and and review my private endocrinologist nexus letter evidence for my diabetes type II claim - which they denied. It appears, after my claim was decided, the VA conducted a review that determined they did not get all treatment records from the VA and did not consider my private medical records. They called it late flowing evidence (even though they had my private treatment records since the day I filed my claim) and tried to just address the DM II aspect of the claim as a reconsideration EP 20. When they they submitted that to the rating board, the Memphis RO told them that the EP 020 was incorrect and they had to re-rate ALL the contentions as an EP 930 because the evidence was received before the previous rating was completed. Based on the Memphis RO directive, the way the RO decided to handle this EP 930 was to send me out for 3 new C&P exams to redo all the C&P exams that were performed on the original claim (eyes, ears, and arthritis and tendonitis) as requests for increase. I presume this was a "failure to assist " deficiency they had to correct with new exams because the previous C&P examiners did not have access to ALL my medical records. All other items that were previously denied in the claim as not service connected without C&P exams (arthritis) would be reevaluated as new claims in the EP 930. As part of the EP 930, the new C&P hearing exam by the VES contractor was far more detailed than the first VA hospital C&P hearing exam and came back with results which should place my hearing loss at 50%. Speech discrimination of 24% on left ear and 60% on right ear. The audiologist performed, in addition to air conduction, additional conductive tests(bone) and immittance tests. All immittance tests were abnormal except one. The audiologist cited that my right ear hearing loss was more likely than not related to service. This would make the hearing loss bilateral instead of just left ear. Also, favorable functional impacts of hearing loss and tinnitus were provided. Now the VA has finally started the re-rating portion of the EP 930 claim and want to schedule me for another NEW audio exam. I do not understand this. It appears that the last C&P hearing exam for this very EP 930 claim was too favorable to my claim. It appears they are diagnosing to deny. The 50% hearing loss would place my combined rating over 90% and should be supportive of the TDIU I filed which is in the current EP 930 claim. What should I do? Sidenote: While I have been waiting for this EP 930 to be completed, the original 80% combined claim that started this fiasco is now final (over a year old).
  2. The Monday Morning Workload Report has surged from 21,000 claims to over 33,000 in the past few weeks. These EP 930s are the type of claims that the VA OIG recently cited in an investigation as ways to understate the VA 125 day backlog by moving claims where errors were made that they do not include in there backlog statistics. The OIG Investigation used data from 2016 and released its report on Sept 10, 2018. Rather than correcting the problem, it appears to have gotten much worse over the past few weeks. This flies in the face that the VBA told the OIG that this problem would be corrected by 31 December 2018. The following is taken directly form the OIG Investigation: ...VBA’s reported backlog did not represent all claims that had been awaiting rating decisions for more than 125 days during the first and second quarters of FY 2016. The OIG estimated VARO staff completed about 63,600 other EPs that required rating decisions that took over 125 days to complete and which VBA did not count as part of the backlog. This occurred because VBA leaders chose to limit which EPs were included in the backlog. VBA’s reported backlog statistics could be unclear to some stakeholders regarding its progress toward eliminating the disability claims backlog. The OIG estimated that in its completed backlog, VBA only reported about 239,000 of 302,000 claims (79 percent) that required rating decisions that took over 125 days during the first and second quarters of FY 2016. More importantly, VBA generally prioritized its workload of rating EPs over other EPs, resulting in significant delays in processing other EPs that were older and required rating decisions. 16 At the end of May 2018, VBA reported that its rating EPs were pending an average of approximately 90 days. However, the OIG found that VBA’s additional EP categories each included cases that required rating decisions, and the category with the lowest average days pending was reported as being about 142 days... ----------------------------------- VA Response: Review of Accuracy of Reported Pending Disability Claims Backlog Statistics The Veterans Benefits Administration (VBA) concurs with the findings in OIG’s draft report and provides the following comments in response to the recommendations. Recommendation 1: The OIG recommended the Under Secretary for Benefits consider revising which claims are included in VBA’s reported disability claims backlog and provide a clear definition to all stakeholders. VBA Response: Concur in principle. VBA is currently reviewing how best to supplement or adjust reporting on the rating-related backlog since such reporting has been essentially unchanged since reporting began in 2009. VBA will consult and collaborate with stakeholders to make certain any proposed changes to reporting on the backlog are well understood. Target Completion Date: December 31, 2018.
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