Backpay

Hello, Finally granted some issues Dec. As of a couple weeks ago it moved from waiting for decision to a decision has been made but needs final sign off. Any idea how long that typically takes? Also is it true that when assigning a rating I'm supposed to have a CP exam within last year?

Ok that sounds good. Thanks so much! Fingers crossed .

What exactly is an appeals coach? I'm waiting on 2 decisions and a remand. Basically I haven't worked in a month and looks like it's going to be continuing possibly that way because of covid-19. I got an email today saying that an appeals coach is going to try and get to my file today. Is an appeals coach someone who does ratings and figures out back pay and all that?

I talked with "Peggy" and it sounds like I just have to wait and see if they screw up this claim again as i have no arm motion limitations and it's all centered on forearm, wrist, hand, fingers. So if/when they do screw it up again I guess it will at least give me an opportunity to switch out from this legacy appeals process and get into the new AMA process?

This was first appointment from last VA Dr I really complained to about this before giving up on getting it better. This note below pretty much makes it clear IMO what the issues are. I also ended up asking later for occupational therapy who said they couldn't really do anything either. They said some ultrasound therapy that helps break down scarring could help but they didn't offer it there. There is another note saying how braces made it worse when I tried them. So my symptoms of the hand , fingers, wrist and forearm are linked to the tenosynovitis. This 30-year-old right-hand man works as a dispatcher, often doing computer work, and is referred by Dr. D for evaluation of his right wrist. In 2006, while on active duty, he noted a painful swelling in the volar distal right forearm which eventually became painful. An MRI was negative, and he underwent surgery in 2007. A "radical tenosynovectomy" was performed. The pathology indicated "dense fibrosis without malignancy." He underwent therapy after this. However, he has had ongoing symptoms in the right hand and forearm. It has worsened over the past year. The pain starts at different places. For example, sometimes it begins at the volar scar, other times in the fingers or the thenar area. He also notes intermittent numbness of the radial 3 digits, sometimes at night. Other time, the ulnar 2 bother him. He states because of this he has difficulty playing video games, giving back massages and doing gripping activity such as brushing snow off his car. He has used anti-inflammatories in the past which have helped the left, but sometimes made the right worse. He has had elevated liver function studies recently and thus has not been on any anti-inflammatories now. The left hand has been bothering him, which he feels is due to compensating for the right. He has pain dorsally in the hand and wrist with some popping. There is also some numbness of the left hand. PAST HISTORY/REVIEW OF SYSTEMS: He has a history of tobacco use, hypertension, mitral valve prolapse. Medications were reconciled. PHYSICAL EXAM: He is a pleasant 30-year-old whose height is 70 inches, weight is 210, and BMI is 29. There is a longitudinal incision over the right volar distal forearm extending across the carpal tunnel which was released surgically. Flexion of the right wrist is 80. Extension is 65. He has full motion of the fingers. There was no tenderness whatever in the region of the volar scar, volar forearm, dorsal carpal regions, snuffbox, radial styloid, basal joint. Tinel sign was negative, and Phalen test was negative. Finger sensation was intact. The right elbow fully flexed and extended. Ulnar nerve in the cubital tunnel was sensitive. The left elbow had full motion with some sensitivity at the cubital tunnel. Left wrist flexion was 80. Extension was 70. He had full motion of the fingers. There was no tenderness whatever in the left volar or dorsal forearm, carpal bones, or hand. Resisted extension of the wrist was not painful. Tinel sign was negative. Phalen test caused numbness of the ulnar 2 fingers only. Phalen was negative on the right. An x-ray of the right wrist from 01/16/15 was unremarkable. Unfortunately, I do not have any answers. I explained if this had been something that was easy to fix he would have been better years ago. As it is, these symptoms have a 9-year head start and in fact are worsening. I cannot demonstrate any tenderness whatever today in either wrist/hand. Although he had his right carpal tunnel released at the time of surgery, some of his symptoms do sound suggestive of carpal tunnel syndrome. I gave him bilateral wrist braces which he could wear at night and intermittently during the day such as if his hands flare up. I would typically use anti-inflammatories, but because of his elevated liver function tests I do not feel this is an option. I offered to send him to therapy for an exercise program, but he feels that he does not really want to do that now and will use the braces alone for now. He will make an appointment for 3-4 months and will cancel it if he does not feel he needs it. It appears that this is something that he is going to have to try to live in harmony with because I really do not have any other suggestions for treatment. He apparently fractured his right arm 10 years prior to the onset of swelling, but I would not think it would be connected to his present problem.

Thanks for the info so far I appreciate it. I went back and found the original dbq on the tenosynovitis and saw the said I didn't complain of flare ups or fatigability which I know I did. Hopefully the rater checks all my records and disagreements which clearly show I do and have complained of those issues. I am going to check out the above links though. At least 10% does sound like the right starting point because it does legitimately interfere with my work.

I recently won connection on appeal for 2 disabilities. One of them is tinnitus so I know I should expect 10% for that. The other is for right arm tenosynovitis. If it helps here is my decision https://www.va.gov/vetapp19/files12/19191030.txt . From memory during the C&P exam years ago my range of motion was within normal limits for my wrist. I have a scar on my forearm starting about a third of way down to a couple inches into my hand from the surgery. My records and everything show complaints of intermittent pain in forearm, wrist, and palm next to scar among other things. However during flare ups especially when I try to use hand for small dexterity things my entire hand and wrist cramp up and my range of motion is severely diminished until I rest it. I can't really use manual tools without problems, at my last job I typed a lot so I was in pain a good amount of time and had to take breaks. At current job I have issue when I handle small parts. My hand will sometimes shake and I've dropped them. I've had to buy motion isolated leaf blower at home to help reduce pain as well. Problem is most of time it's ok and during exams I haven't had flare up. So I'm really confused on what code should even be used? When I'm given a rating how do I know they chose the appropriate one? The other thing that has me worried is that the VA.gov website shows this as the granted issue. Service connection, Limitation of arm motion Does that mean forearm, wrist and hand? That's where my issues are and the combined all my other claims that included those because I wasn't sure how to claim it when I filed way back when.

Just thought I would update and give story a conclusion. I wasn't feeling up to going to clinic and talking directly to patient advocate so I sent a secure message this morning and am happy with the results. She was very appreciative of my message and detail provided and she was able to piece everything together. She just called me and explained everything and said they will be taking steps to prevent this from happening in future and staff in general will get additional training. I also suggested that when VA employees say something can't be done to offer alternative solutions and help problem solve using their knowledge of the VA system. So I'm happy, VA is happy and hopefully this helps prevent issues for other veterans in the future. Couldn't ask for better outcome.

My mistake, people can't read my mind and if I don't make it clear can take it the wrong way. I'm happy all is well, in fact things worked out better for me mostly and I'm completely happy about that. I'm upset about the fact of what almost happened. I'm upset that it could of happened to ANY veteran. I know better, I know not to trust the VA I know that you need to double and triple check things, get it in writing, be proactive and go above and beyond to make things happen with the VA but I know that there are many veterans who don't know that. There are many veterans who do fall through the cracks, who do get screwed over like you in your story. To me all of it is unacceptable, it's a systemic issue with the VA so they don't deserve any type of pass or understanding IMO. I also think it's our own fault as Veterans for not raising all these issues and not really trying to pick on you but when we say how we've had it worse and it is what it is so don't complain is BS and doesn't help us any. I was told by 3 people I was all set and not to worry. I saw the problem a mile away and made it known to all involved and it still happened. No veteran should have to deal with it. Also I'm actually devoting my recovery time to fighting the VA on the issues you had. The fact that they clearly violate federal regulations and screw over veterans and their claims and don't pay out for years and leave veterans in awful places like you. I've reached out to a couple veteran organizations already and have heard back that they agree completely. If I get my money tomorrow for my claims in still fighting this issue for other veterans. But hey I guess we can fight amongst ourselves and do nothing? ETA: before I get upset over these things I ask people around me if it's rediculous. Friends, family, and even in this case medical professionals. The stunned looks I get and the disbelief that these things actually happen leave them in shock.

I'm wondering if patient advocate is the correct person to go to or if someone else would be better or let me know if I'm overreacting. So Tuesday I went to a community provider for surgery to have gallbladder removed and part of my colon removed as well. The VA approved it ahead of time so that should be all set. On Wednesday the hospital social worker came to my room and verified the VA would be my pharmacy and we talked about the requirements (VA needs prescription and notes to approve or deny themselves) and she said she had a VA contact who she was working with and that she faxed it over. The social worker then gave me the paper copy of prescription and the fax sheet that she used. Unfortunately I was going to be in hospital longer then expected (got out tonight) so Friday morning I sent secure message to them to verify I was all set for prescription. After a back and forth I was told they "finally received it". I was told that they were working through the issues (assume no notes sent) but that it would be ready for me to get Saturday (today) and that I could just show up to get it before 4 pm. Later that day I got a voicemail reminding me to ONLY bring the paper prescription with me. So today it looked likely I was going home but there was no way before 4pm so I called up the VA to make sure my wife could grab it for me. So I called and asked to speak with the pharmacy there and not the national number they normally transfer you to. I explained my situation to a person at the actual clinic I go to and she put me on hold to look into it. She said she checked and there was no prescription there for me and that I should of known procedure to bring in prescription with notes so a provider could look everything over and approve or deny. I gave her the names of everyone I spoke to and she said it wasn't possible as there were no providers there on the weekend. So I'm pretty upset at the idea I could of been discharged on a weekend without access to pain medicine I was told I was all set to get. Luckily I double checked and worked with the hospital and found another way but I can't even imagine the agony I would of been in waiting until Monday.

Yes it's totally rediculous. I read another thing that I can try as well. I plan on faxing over a demand for action letter on my claim. We really shouldn't just give up and on this and we should keep calling Peggy and our representatives bringing up this violation of our due process. If I have to follow the law a Federal regulations why doesn't the VA? Is it's excuse they are understaffed? Well maybe I'm to busy to pay my VA co payments? Definitely a double standard.

I have been giving this more thought. Monday I am going to my congressmans office since I have surgery Tuesday and will be out of commission awhile. The more I think about this and research it the more I realize how wrong veterans are being treated by the VA and how they don't even try and hide it. Aside from my grants which should be super easy for VA to do, the VA website says remands typically take the veterans benefits administration (agency of original jurisdiction) 16 to 29 months to complete. So if a new claim takes 82.4 days to receive a decision and federal regulation requires claims going back to VBA from BVA to be handled expeditiously this clearly shows a violation of regulation and our due process rights. I've been trying to reach out to a lot of people over last day or so, hopefully something comes of this so all Veterans will have their claims handled properly and in a timely manner.

Some more relevant issue regarding word expeditiously. https://www.federalregister.gov/documents/2019/01/18/2018-28350/va-claims-and-appeals-modernization N. Comments Concerning § 3.2502—Returns by Higher-Level Adjudicator or Remand by the Board of Veterans' Appeals Several commenters expressed confusion over the inclusion of the term “adjudication activity.” VA agrees that our use of this term in the proposed rule was confusing. Accordingly, VA revises § 3.2502 to use the term “agency of original jurisdiction” throughout the final rule. Similarly, commenters requested further clarity on what it means to “take immediate action to expedite readjudication.” The AMA amended 38 U.S.C. 5109B to state, “The Secretary shall take such actions as may be necessary to provide for the expeditious treatment by the Veterans Benefits Administration of any claim that is returned by a higher-level adjudicator under section 5104B of this title or remanded by the Board of Veterans' Appeals.” VA agrees that clarification is necessary and revises § 3.2502 to more closely mirror the statutory language. The statute does not further define what is meant by Start Printed Page 147“expeditious,” leaving timely treatment of claims to the Secretary. Clearly, Congress intended that VA would process these claims as expeditiously as possible depending upon available resources. VA will similarly not further define “expeditious” in the rule to provide the Secretary the discretion to direct expeditious processing of actions through allocation of available resources, appropriate prioritization of workload, and issuance of procedures.

Called Peggy with questions on regulations who said I had to escalate it and suggested white house hotline. Called them and got conflicting information. Basically I was told they don't give estimates but estimates given on website are based data such as claims, information they have, workload etc. But they are just estimates. He couldn't help me but I also mentioned that if they have data they use to give those estimates on website then it would be crazy to think it should take double the higher estimated timeframe. Also said that appeal grants are treated totally different and in seperate pile for handling then new claims which again seems crazy if appeals once given back to the RO are supposed to be handled expeditiously. He said I may have different interpretation of expeditiously and I just said to me expeditiously should mean faster then the standard claims. So to me personally it seems like the VA is playing games with optics and timeframes to make themselves look better. So the fight continues, at this point since I tried handling it on the lower levels I'm going to prepare letter for my congressman and for the office of inspector general as well as see if there is an investigative reporter who would like to do a story not on me but on these "estimated timelines" and possible regulation violations.

Congratulations! Seems like your in the same boat as me. Feel free to check out my topic here I'm fighting to get my money faster. I feel I have found the appropriate federal regulations as well. Good luck!

So I'm finding more and more info that I feel will help. See the following which is found in federal regulations regarding adjudication of claims. https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=549cda86648188a6a068def5530850c9&rgn=div5&view=text&node=38:1.0.1.1.4&idno=38 §3.2502 Return by higher-level adjudicator or remand by the Board of Veterans' Appeals. Upon receipt of a returned claim from a higher-level adjudicator or remand by the Board of Veterans' Appeals, the agency of original jurisdiction will expeditiously readjudicate the claim in accordance with 38 U.S.C. 5109B. The agency of original jurisdiction retains jurisdiction of the claim. In readjudicating the claim, the agency of original jurisidction will correct all identified duty to assist errors, complete a new decision and issue notice to the claimant and or his or her legal representative in accordance with 3.103(f). The effective date of any evaluation and award of pension, compensation or dependency and indemnity compensation will be determined in accordance with the date of receipt of the initial claim as prescribed under §3.2500(g). [84 FR 172, Jan. 18, 2019] i then searched all of the sections under adjudication and found that the word expeditiously is only used twice. Both times regarding how the VA must handle claims sent back to them from a higher authority. why is that important? It shows that regulations require they be handled faster then a standard claim. So I definitely should have received my rating and back pay by now. so I guess I could also go the route of inspector general now since I have reason to believe federal regulations are not being followed.

Like I said I'll keep updating this thread throughout my journey so that it may help someone else. I sent the about info last night to my VSO and they called me this morning but I was sleeping. Waiting on another call back from them. But here is a new question. So if the DRC takes 30 days if I filed it today would that mean they would deny it because they would see my file and have to approve the grant from BVA so my fast track claim would be moot?

If I find out anything good I'll definitely update everyone here. Personally I found the following interesting. Let's break down my situation to basic terms. I was granted service connection for 2 disabilities. 1 for tinnitus which is 10% rating no matter what. The other for tenosynovitis which would require them to look at the evidence they already have in their possession. The remanded issue is because the examiner didn't get all the info they were supposed (this is for an increase in an established SC disability because I disagreed with initial rating) and the judge said the RO didn't bother to look at relevant medical records from a 2 year period. These are some interesting facts though when considering the above. According to the VA in December the average time for a decision on a new claim was 82.4 days. That includes getting all the evidence, reviewing it, deciding if it's service connected, and at what rating. https://www.va.gov/disability/after-you-file-claim/ Personally I'm inclined to believe that it's so fast for new claims because like my remanded issue they don't do what their supposed to and deny claims to make those wait times look better. But let's say they are doing things properly for the sake of everything. 83 days after RO received order from BVA to grant me 2 SC disabilities will be February 26th. So why when most of the work is already done is it taking that long to get my rating? Again VA website said I should expect it in 1 to 2 months. The VA also claims to decide claims for increases in disability if you file decision ready claim and work with veteran service organization within 30 days. I have a VSO representing me and essentially the BVA gave me service connection so the VA is just processing an increase and according to person I spoke with on phone my case has been in decision ready status since December 5th. I definitely feel like I'm finding more and more information to use to speed this up especially if I call congressman.

Thanks for your reply I really appreciate it. The remand was because the examiner didn't get all relevant information needed to determine a proper rating since I disagreed with 0% rating. They also apparently didn't look at more medical records over 2 year period that were related. I think your right about congressman. I might try the Whitehouse hotline number first for veteran issues then if that doesn't seem promising reach out to congressman. Are there any regulations your aware of for timelines in which VA has to respond to BVA or anything else like that so I can use it to hold feet to fire?

So I called again.... I was told that the 1 to 2 months timeframe is always listed and essentially means absolutely nothing. Won't lie kind of upsetting especially considering the scandals with VA and wait times for medical care so it seems like they care about appearances vs actually following through of time frames. Was also told the Dec 5th date was the date someone at the RO got my file back from BVA and updated the status. He said it's been in the ready for decision status since Dec 5th and that they need to determine effective dates and percentages and basically go through everything again and there is no way to know if it's actually being worked on or not.

My surgery is unrelated. I'm having section of colon removed because of recurrent diverticulitis and gallbladder removed at same time for polyps to rule out / prevent cancer. I'm going to be on short term disability during my recovery time so Ill be making less money during the time I'm out. Currently rated at 10% and judge ruled in my favor for tinnitus and range of motion for right arm because tenosynovitis and surgery that occurred in service. Remanded issue is for increase in rating for scar from said surgery. I've called a few times. I've been told that the remanded issue has an order in and that the RO has my file and that it takes time to figure out backpay. They also don't have any estimates on timeframe. Called back again after almost 3 month mark because the VA website specifically says if the decision resulted in increase in disability rating it should take 1 to 2 months. This time agent I spoke with said that he never even heard about estimates on their website but it would be just that an estimate. So I asked if it would be crazy for it to take 4 months which would be double estimate and he said no. In the past when I filed for increase I had it within weeks after exam. I also asked the person if I could talk to anyone else about the issue and they suggested the BVA but I said it's with RO right and they said yes so the BVA would be no help then they gave me the claims fax number which I don't think will be helpful at all either.

Hello, Dec 5th I won 2 parts to my appeal and had 1 remanded. 1 of the disabilities awarded is tinnitus. On the VA.gov website it says that it should take 1 to 2 months for the new disability rating to be reflected. It's been over 2 months and nothing. I called the national number and they could only say it was at my RO (that was a month ago) , I contacted my VSO who didn't know anything either. How long does it normally take? I'm going to be out of work for 4 to 6 weeks because of surgery that I have next week. Thanks