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flow1972

Third Class Petty Officers
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Everything posted by flow1972

  1. 38 U.S.C. 501 Section 3.327 Reexaminations General. Reexaminations, including periods of hospital observation, will be requested whenever VA determines there is a need to verify either the continued existence or the current severity of a disability. Generally, reexaminations will be required if it is likely that a disability has improved, or if evidence indicates there has been a material change in a disability or that the current rating may be incorrect. Individuals for whom reexaminations have been authorized and scheduled are required to report for such reexaminations. Paragraphs (b) and (c) of this section provide general guidelines for requesting reexaminations, but shall not be construed as limiting VA's authority to request reexaminations, or periods of hospital observation, at any time in order to ensure that a disability is accurately rated. (Authority: 38 U.S.C. 501) (b) Compensation cases - (1) Scheduling reexaminations. Assignment of a prestabilization rating requires reexamination within the second 6 months period following separation from service. Following initial Department of Veterans Affairs examination, or any scheduled future or other examination, reexamination, if in order, will be scheduled within not less than 2 years nor more than 5 years within the judgment of the rating board, unless another time period is elsewhere specified. (2) No periodic future examinations will be requested. In service-connected cases, no periodic reexamination will be scheduled: (i) When the disability is established as static; (ii) When the findings and symptoms are shown by examinations scheduled in paragraph (b)(2)(i) of this section or other examinations and hospital reports to have persisted without material improvement for a period of 5 years or more; (iii) Where the disability from disease is permanent in character and of such nature that there is no likelihood of improvement; (iv) In cases of veterans over 55 years of age, except under unusual circumstances; (v) When the rating is a prescribed scheduled minimum rating; or (vi) Where a combined disability evaluation would not be affected if the future examination should result in reduced evaluation for one or more conditions. The VA is notorious for not following this rule, but unless a new claim is related to an existing condition by being a secondary condition or the claim is requesting increase of an existing condition the above rules should be applied. Meaning, no periodic future examinations should be requested for "static" conditions, "permanent" disability, or when a veteran's age is over 55...EXCEPT UNDER UNUSUAL CIRCUMSTANCES. So..there isn't a law that they cannot reduce after age 55, but there is one that they aren't supposed to request exams where they "could" reduce after age 55 unless there is an "unusual circumstance"...and you'd better believe I'd be asking them to provide documentation on what that is.
  2. Isn't there a regulation about a rating having to be based on a condition as if it were "unmedicated"?
  3. Answered my own question..55 is a "protected status" from future periodic exams. But if you file a claim, they can review anything they want; but there is always the "long period of rest" argument in cases where you aren't working. Regardless, Tinnitus wouldn't be re-evaluated because it's already at it's lowest level; and I'd guess that your heart issues have likely not "improved" with age.
  4. Just going to point out that the OP is 73 YO. Isn't there a law that states that cannot reduce after age 55?
  5. I should have read this before I posted my most recent question. LOL!!!!!!
  6. Yep, 2 kids in college on Chapter 35. They get removed as soon as they start getting it.
  7. So, my hubby went straight from 10% to 80% back in May then a week later to 100% P&T. I had (back in 2020) filed a dependent claim in anticipation of the appeal we had out there to hopefully ensure they calculated backpay correctly with the dependent info on-hand. So..that didn't happen. When they calculated backpay, they only included myself as the spouse and didn't include our daughter who was 17 at the time of effective date. I called and asked what to do, and I was told to file the correct forms to have her added and that as long as they got the information within a year of the 80% award date, they would go back and backpay for her. I filed the 21-686c and 21-674 and literally put in the notes on both forms that the forms were for backpay only. I gave all of the dates, her graduation from HS date (she was 18 for her last 6 months of HS), and the date she began getting Chapter 35 benefits (from me). I mean, you would think this would be fairly easy stuff, right? Uh no. Somehow the dependency claim got stuck in limbo. A friend looked up what was happening for me and told me it was assigned to someone in Seattle then it get put back in the queue and someone else in "DC" picked it up. Then it was put back in the queue with no "trigger" to drop back down in to the work list for someone. (I don't know how all of that automation works, but apparently this was not correct procedure.) I was told to call the 1-800 number and have someone look in to it so that it could be corrected. First call.."I'm going to have to do a report on this. Let me put you on hold while I look in to something..." call disconnected. *sigh* I call back. Second call, "Well it looks to me like it's showing "Administrative Error". That's all I can tell you." Me: "Can you put me in touch with someone that can tell me what's going on? It's been 2 months since it was filed, and it shouldn't take 2 months to process." Agent: "I can put you in the Supervisor Queue. Hold on while I connect you." Call disconnected. *sigh* Good Lord. I wait another week...still nothing. I call my friend again and ask what else can I do? Well...you can file a Statement In Support of Claim and list everything in there that's happened. It should force the system to bring it up and get someone to know it needs to be worked. Ok, did that. Waited another 2 weeks...still no movement. I finally logged on to eBenefits a few days ago and clicked on the "Request Decision" button. It showed "Error". (insert me rolling my eyes) Then, I logged on to eBenefits yesterday to see if there was any movement. Yep, it is now in "Preparation for Notification" status. Finally! Here's the odd thing though that has me a little freaked out. When I look at "Dependents On Award" in eBenefits now, it doesn't even show ME on there anymore! It shows myself and our daughter under the "Dependents Not Currently On Award" list!!! I was like.."What in the Holy Hell are they doing!!!??" Call my friend...already off work. Will take a look Monday if you remind me. Uggghhhh I call the 1-800 number again to see if they can tell me what the heck is going on...."It shows someone is in the file right now. Sometimes when they are working on a file adjusting dependents it'll "reset" them in the eBenefits list. I still show you on the Award." Me: "I still show on the award in VA.gov as well. Can they just remove a spouse for no reason?" Agent: "They could if there was notification of divorce or something..or the Veteran hasn't responded with information requested." Me: "Well, that's not the case." Agent: "I'm sure it's fine." Given my experience, I'm not "sure it's fine". Does anyone have experience in this?? I will absolutely pull my hair out if they go and remove me and try to get the backpay already paid out back or something crazy. It should not be this difficult to correct dependents. It just shouldn't. The friend that's looked at this for me said he fought for 2 YEARS to have his newborn added to his backpay award correctly. They kept telling him that they would only pay to when they "first became aware of the child" not her birth date or some ridiculousness. He gave up. This kind of stuff is what freaks me out about all the crazy I'm seeing with this...
  8. I’ve heard a lot about how bad C&P’s were years ago. I feel lucky to have gone through the process more recently. Glad you eventually got what was due.
  9. Took my husband's attny 8 months to get it last year. I had made multiple attempts at requesting it...never got anything. At least you got it LOL.
  10. My husband was just rated 50% on Migraines due to TBI in Service. I agree with the advice to claim Migraines as long as you can give a reason for Nexus. The diagnosis is already in your file by the definition of your symptoms. Don't over think this stuff. If you want to include the Mayo Clinic symptomology for Migraine, it doesn't hurt. Also, I made my husband keep a headache journal for several months in preparation of the C&P as well as provided to his VA PC Doc. He already had the prescriptions in history for the Migraine meds as well as emails to his PC requesting further evaluation due to frequency and severity. He had started quarterly treatments of some kind of gel stuff that put in up his nose by the time the C&P came around. The rater took all of that and granted the correct rating. Items documented in journal: Date, (approximate) Start Time,(approximate) End Time , Intensity 1-10, Medication Taken, Required Lying Down In Dark Room (Y or N)
  11. Light sensitivity is just a symptom of a Migraine. It has no bearing on whether the Migraine is related to service or not.
  12. This is the same for spouses. My husband is SC on TBI and rated for Memory Loss. The C&P exams always ask him to answer questions about past events...with a memory issue. LOL I mean, it's not funny..but it's funny how ridiculous it is. I know him better than anyone, so I would go over with him the night before what the C&P he was going to was for and make notes for him so that he didn't forget anything. I hope you get the reduction reversed.
  13. Yep. In our State our Property Tax is reduced by the first $45K of property value, Tuition is waived for all State accredited schools for spouses or dependents, we can purchase a Sportsman's License for $12 per year verses the normal $94 per year, etc...
  14. It's been around 3 years or so since I started down the VA Claims path. From what I've seen reading through these forums, that's a really short period of time to have achieved what I've been able to. I've had a great deal of help from others on this site, and I've had my share of frustrations with the VA as well. In the end, it was absolutely worth it. My hubby and I are both Veterans. I started this whole VA thing more than 20 years after leaving service. Neither one of us knew anything about the VA until we got involved in a group with a bunch of Combat Veterans who convinced me that it would be worth my while to at least take a look at it. As of last week, we are both now 100% P&T. I've learned a lot along the way, and I try to help others with what I've learned as much as possible. Some tips: 1. Be organized with your claims. Site what you're claiming, what evidence you're using, and then highlight what you want them to read on said evidence. 2. Prepare for the C&P by reading their rating guidelines. Don't just show up. 3. If you don't have an event documented that actually happened, get a buddy statement. More than one if you can. The more, the better. 4. Do your research on what you're claiming before you submit it. 5. If some of your evidence is from PMR's, only submit what supports your claim. DO NOT grant the VA blanket access to your Private information. They will try to get you to sign a form giving them access, but the law only requires you to submit evidence that supports your claim. Don't cause yourself unneeded problems. 6. If you end-up hiring a lawyer, don't expect them to be as thorough as you would be about your case...or as fast. They will literally wait for the 1 year dead-line for appeal to actually file the appeal. And it won't be some multi-page legal brief. It will literally be one or two sentences siting the part of the law that was violated or whatever the basis for the appeal is. You will most likely never even speak directly with an actual lawyer. You'll deal with their legal assistant. Like anything else...some advice the legal assistants give is good..some isn't. If I'd listened to the legal assistant's opinion that filed the appeal for my husband, he wouldn't be at 100% P&T today. 7. When in doubt, claim it.
  15. @broncovet, yes. I already knew all of that. I’m just having our daughter added to get the retro pay for the time between the Award Effective date and when she began getting Chapter 35 benefits. It’s just convoluted when it’s all back dating for age and so forth.
  16. Thanks! Yeah, he's signing the forms; I'm just the secretary. LOL I handle everything VA related for him because I understand it so much better than he does. After I got to 100%, I really started getting in to his and researching for him. He was literally only SC'd on Tinnitus. He is a Combat Vet. Anyway, the initial claim I made for him was for OSA, Migraines, and RLS. I had him get the required Buddy Statements (we got 3...one from each duty station where he shared sleeping quarters plus mine) since he never went the the Dr unless he was "dying". First pass by the VA..denied without a C&P. I was having a very difficult time with his claims because he didn't have his SMRs, and I just could not get them. We decided to get an attny since I just didn't have enough to go on. (I wish I'd known more then LOL). Took even the attny 8 MONTHS to get his SMRs! They waited literally to the year mark to file the HLR basically just citing the court decision where they are supposed to accept lay evidence and failed in their duty to assist by granting a C&P. Ta Da...C&P granted. I was keeping a headache log for him over that time period as well. During that time, I was able to find in his records the actual event (described in detail) where he had a major accident where he rcvd a TBI while deployed. It was EXACTLY what I needed. I filed for Residuals of TBI, Sinus Condition, Scar to his face, Unstable Scar, Deviated Septum, DDD, and Bilateral Sciatic Nerve Paralysis. He was doing the C&P Exams for the HLR at the same time as for the new claim for TBI. I really believe that's why his HLR came out in his favor. The migraines decision specifically mentioned the head injury claimed in the TBI. I didn't know it back when I filed the original claim, but TBI can cause OSA, Migraines, RLS, and a host of other issues. He was granted 50% for Migraines and 50% for OSA..still waiting on the decision for RLS (they forgot to do the C&P for that) and the others should come in anytime now....they are in "Awaiting Decision Approval".
  17. Good luck! I really didn't have an issue tying my GERD and IBS as secondary to PTSD. It doesn't have to "cause it". It just has to have the potential to "worsen" it.
  18. After 2.5 years, my husband won an appeal that put him at 80% SC'd up from 10%. Since you cannot have a dependent on your award until you are at least 30%, the VA did not add our daughter to his award. I had filled out the form on line back in December of 2020; but they ignored it when the award was done. I was on the award as the spouse, but not our daughter. Sooooo to complicate things, our daughter was under 18 on the effective date but isn't now...then add in that she began collecting Chapter 35 benefits (through me) in June of 2021...and it's a mess to figure out how to get the back pay for my hubby's award. I *think* I have it figured out, but please let me know if I'm wrong. I filled out a 21-686c and a 21-674 (the online one is just not setup for this kind of scenario). I put in the dates on the 674 as they would have been filled out had I done it last year...showing High School ending 5/2021 and College Beginning 8/2021 with Chapter 35 also starting 8/2021. In the "Remarks" section of both forms I put the statement: This form is for retroactive dependent pay associated to Decision date 5/23/2022..etc... Anyone else dealt with this before? Such a PITA. With this type of thing happening so often, it seems they would have a form specifically for this.
  19. I agree with @brokensoldier244th. It really depends on a lot of different factors. Every single HLR is different. The HLR decision on the one I did was in and complete within 3 days, but mine was a literal math error I was able to point out specifically in the Original Evidence, so it was an easy thing for her to see. Still, it wasn't "immediate"...and that was a while back as well. I wouldn't submit anything "new" no matter what though because then it wouldn't be an HLR..it would be a supplemental. HLR's don't allow any "new evidence". I'm sure it'll happen soon. Good luck!
  20. Going through and assisting my son with his taxes yesterday, and I had to do a bunch of research on how Chapter 35 affects AOTC and/or LLC education credit. It was astounding to me how many "experts" threw out answers about what a person could and could not do with regard to the education credits that were completely WRONG. Here's the actual low-down for anyone who is confused: Chapter 35 is NOT the GI Bill. There is no benefit within Chapter 35 that is "required to be used for educational expenses". Chapter 35 payments are the "equivalent" of BHA payments in the GI Bill program. Most "States" offer a Tuition "waiver" or "reimbursement" for people who are eligible for Chapter 35; but that money does not come to the person "through" Chapter 35 or the VA. When discussing the Federal Education Benefits, you would absolutely file the 1098-T the school sends you. What it will show is all fees and tuition "required to be paid directly to the institution" (Box 1)in order to attend. It will also show all "grants" and/or "waived" Tuition paid by the State or any other benefit program. (Box 5) Most of the time, a Chapter 35 recipient will have a higher number in Box 1 than Box 5 since typically (unless receiving another grant/scholarship) includes the "other than Tuition" fees the school charges (i.e. labs, equipment, insurance of some sort, meal plans, etc...) In that section of your taxes, you would enter the amounts the school shows in those boxes. Then, you would enter any "additional eligible expenses" you incurred (i.e. books, etc..) required to attend but not required to be paid directly to the institution. In my son's case, that would be over $700 (note: parking/transportation is not an eligible expense). Then, you will answer "Yes" to the question asking if you participated in a plan run by the VA. In that section you would enter $0 for the amount of the money you got from the VA that was "required to be used for educational expenses" because the Chapter 35 payments are NOT required to be used for anything in particular. They can be used for whatever the recipient deems necessary. The only time you'd enter anything in that box would be if you received a payment from the VA that was SPECIFICALLY REQUIRED TO BE USED FOR AN EDUCATION EXPENSE. This is usually something existing in GI BILL PAYMENTS FOR TUITION NOT CHAPTER 35 PAYMENTS. Please don't lose tax benefits you or your dependents are eligible for due to really bad information given by some "expert" on the internet.
  21. I’m not sure if the appeals process is the same for TDIU as it’s for regular claims…but I would think it is. But since what you’re describing is a process error…it may require supplemental to submit the correct document. No matter how much the VA violates their own laws..we are expected to follow them to the enth degree. I used an HLR for a regular claim, and requested a phone call from the evaluator. At that time I explained the error in rating of my original claim based on evidence they had in the original claim. The original rater had not done the math on the prescriptions submitted with the claim, and that math gave me a 30% rating based on their rating table. I was correct, and the HLR rater gave me the 30%.
  22. You can ask for an informal hearing where the HLR rep calls you. You can explain the reason for your HLR then as long as you are arguing evidence they already have in the original claim or C File at the time of the original claim.
  23. I’m not sure if they’ll “deny” it, but they won’t use it in their consideration of the appeal…so there is no “benefit” in including it.
  24. I want to clarify this statement. The way it's stated is absolutely not true. Statements like this confused and frustrated me when I first started down the VA Road. In order to grant, yes a doctor's opinion connecting the condition to an event or already existing condition is required. However, it is not in any way required to have this before you file. In most cases, the C&P is where this is opinion is created. The only time this would be needed external to a C&P is if the C&P evaluator decides the nexis doesn't exist or isn't sufficient for whatever reason; and you now need to appeal that decision with an IMO (Independent Medical Opinion) or the VA is refusing to grant an exam for some reason. If you have one already...great; but it is NOT required prior to filing. When I applied for my PTSD, I was told things like "Only a VA Dr's diagnosis of PTSD will be accepted" and so forth when in fact, I was granted SC for PTSD without EVER seeing a VA Mental Health Professional to this day. My diagnosis was made by my Private Mental Health Professional who completed a DBQ for me to submit with my claim. That diagnosis was then "validated" by the VA's chosen C&P Evaluator when they did their 3 hour C&P Exam. I was so freaked out that I'd done it wrong because of this type if information. In my experience, don't over-complicate things when you don't need to.
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