LKF050813

The way I understand PacMan is I can’t apply now bc at only being rated 80%, I currently don’t rate it. I have a pending claim for s/c increases and new TDIU claim. If I end up high enough, I could rate SMC and either automatically qualify for it or file for it at that time. Anyone and everyone feel free to correct me if I’m wrong. Still learning as I go here.

Got it. Again, thank you so much for taking the time to share your knowledge about all of this. I’m beyond grateful to you and this community

Going to answer my own question because I think I discovered the answer. Leaving this here for anyone that has the same question in the future. This type of C&P exam is called an ACE exam. From the VA: “If you have enough medical evidence in your file to support your claim, we’ll follow the Acceptable Clinical Evidence (ACE) process. This means we’ll review your medical records and ask you to submit more evidence if needed, instead of asking you to have an exam.” From an independent website: “In addition to covering the conditions listed above, an ACE Exam may also be used in other scenarios when existing medical evidence is adequate for a clinical examiner to assess the level of impairment per the claimed condition’s Disability Benefits Questionnaire (DBQ). This might include cases where a medical opinion is needed to determine whether a disability was incurred or aggravated in service or to assess the relationship between a claimed disability and a service-connected disability. Additionally, an ACE Exam is often used to determine if a disability incurred or aggravated by military service caused or contributed to a veteran’s death.

I just tried to explain this to my VSO, That the VA had an obligation to consider me for TDIU or even notify me that I should apply for it based on my initial rating, and he is pretty much telling me they won’t care now because I didn’t ask for it within the first year after retirement. Based on what I’ve learned here and the IMO given to me, I believe I do have case for compelling the VA to assign an EED to TDIU back to my last date of employment. Is SMC something I need to apply for or will it automatically be added based on my ratings?

Thank you for the thorough explanation, from both of you! I just spoke with my VSO to explain some of this to him and he told me the VA is going to tell me to pack sand. Thanks for the vote of confidence… ”Finally the Courts are holding the VA to account. This should break the backlog of veterans claims in the "Delay, Deny, Wait Until They Die" mode.” I’ve never heard that saying before, but it is sad and shockingly probably true.

I’m currently at 80%, looking to increase to 100% P&T regular scheduler, but also applying for TDIU at the same time. My original thinking was to get one or the other, but didn’t realize I should be trying to get both and can use the TDIU award to try for the EED going back to my last day of gainful employment. What is SMC?

If I appeal the TDIU, do I not get paid for the 100% P&T back pay (since my intent to file date) and regular pay while the TDIU appeal is ongoing? I don’t think I have any other disability that I can claim that precedes what I’m claiming currently. The only way I see a path for a retro back pay is to get awarded TDIU with an EED going back to my last day of gainful employment.

So very helpful! Thank you for sharing and for the heads up to not put exact information on here. I wish I would have come onto this page before I started my claim. I’ve learned so much from the members on here and feel like I’m finally understanding all of this. One of the reasons I never attempted to go for an increase over the last 10 plus years was because the process seemed so confusing and overwhelming. I’ve had 3 different VSO’s and I can say with certainty they don’t know half of what the members of this group know. Let’s say I get rated 100% P&T regular scheduler and they deny my TDIU bc they say it’s moot, if I appeal the TDIU denial, do I not get paid any of the back pay or regular pay for the 100% until the TDIU appeal is finalized?

I’m so you do have both 100% scheduler and TDIU? I was thinking they don’t grant both, but that gives me something to fight for then.

Ok my apologies, I definitely skimmed through your paperwork too quickly and thought you got out in 1985. It's great they eventually gave you an EED that went so far back. I had no hope of that when I started this claim. So my story is I have an 82% rating P&T from July 2011. This is my first attempt at an increase of any kind and also at TDIU. They have been filed concurrently. I have not been able to work since my medical retirement from the Navy and have an IMO DBQ stating my mental health rating of 50% should increase to 100% and that based on a medical record review, I have been unable to work since July 2011. 2 problems may present themselves: 1) The VA may rate me at 100% P&T and then toss the TDIU claim, which makes it hard for me to ask for an EED for TDIU. 2) If I get the TDIU awarded, how do I ask for the extra-scheduler EED? Since it's already filed, can I amend it? Do I just add a statement to the IMO asking for the effective date for TDIU to be my last day of gainful employment? My VSO did not even want me to apply for TDIU because he prefers the P&T route, but knowing what I know now, it seems I should have applied for TDIU first and then go after increases...but I've rung the bell so not sure how to pivot at this point.

Crap. That's what I'm afraid is going to happen to me too. The psychologist IMO is enough to get me 100% on mental health alone, plus I'm looking at increases on some of my other s/c stuff. I don't know what to do at this point. ugh! SMH

Thank you for providing these! I just read through them and see that you applied for TDIU within a year of separation. Do you think that's why they were willing to push your date back? I haven't been employed since I left the navy 13 years ago and I have a psychologist IMO that states I have not been capable of gainful employable since that July 2011 date...but I only filed for TDIU 6 months ago because I had no idea it even existed.

Does anyone know why they might do this? My husband just retired in Sept after 20 and completed his C&P exams in person at Chalmers a month or so ago. He got email and paper mail notification of a second C&P exam request via QTC. It states he does not need to be travel to the appointment, looks like they’re having a second person review his files without him present. Anyone know why they would do that? Are they trying to get a less favorable opinion?

Ok that’s a plan I can get behind. I just know I’m running out of time before a decision is made on this current claim and wanted to make sure I’m even doing it right. Since I’m applying for an increase on s/c and TDIU at the same time, will the VA drop the TDIU claim if I hit 100% scheduler? I have a doctor stating I haven’t been able to work since 2011, but if they decide in favor of the 100% scheduler, I don’t think I could get the EED changed for my s/c mental health diagnosis.

Ahhh, ok gotcha. So an audit on the retro SS pay if it doesn’t add up correctly. Thank you for clarifying! So I’ve been reading other posts and just figuring out the terminology I should be using. Is it possible to get my EED for TDIU (if awarded) changed from date of intent to file to my retirement date if my doctors DBQ and report state I have been unemployable since that date?