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?

Thank you for the reply! Can you expound upon the last sentence? Would I be filing an audit for my original 2011 rating decision?

Ok so your reply might be the answer to the question I just asked PacMan. Does extra-scheduler TDIU mean you’re filing for back pay all the way back to the date of unemployability? My VSO doesn’t know anything so I’m trying to figure out how to file for this on my own. My VA evaluator for mental health stated in my 2010 exam that,”Symptoms noted are depression and anxiety associated with chronic pain leading to difficulties maintaining concentration and attention to routine work duties.” And also, “The examiner noted frequent inability to work due to fatigue associated with impaired sleep.” And, “…the psychiatric disorders alone are so severe as to render the service member unfit for duty.” And, “An evaluation of 50 percent is assigned because of occupational and social impairment in significantly impeded reliability and productivity due to disturbances of motivation and mood.” Last one, “Rating of 50% also assigned because this mental disorder developed in service and is severe enough to bring about your release from active military service.” I was also rated on 5 other physical disabilities not related to mental health, for a total combined rating of 82%. I’ve somehow never read this report before, so I find it very interesting they said all of this. It also makes me wonder why the VA didn’t consider me for TDIU back then when it was clearly stated in the evaluation report that it was impairing my ability to work so severely that they ultimately fired me (my words not theirs). If I decided to file for extra-scheduler TDIU, would I do it before they decide on the regular TDIU claim I have open or let the dust settle and then go back for the extra scheduler?

I just got off the phone with my psychologist that is going to do my DBQ and a full report that states I am unemployable just based on my mental health conditions and have been so since my medical retirement in July 2011. I just read my C&P mental health exam report from 2010 and the evaluator blatantly states the same, not able to work, negatively impacts home life, relationships, ability to take care of self. The psychologist also said his DBQ should qualify me for 100% P&T just on mental health alone. He’s encouraging me to pursue the SSDI and referred me to an attorney in my town that does this. Even though I’m outside of the time limit, his write up will support that I was eligible for SSDI back in 2011 and he thinks that will supersede the time since I stopped working SS requirement. Does SSDI back pay to the date of unemployable? Or does it start when you file? Same question for the VA…is it possible for me to get back paid to 2011 of my paperwork shows I was TDIU then and the VA did not attempt to evaluate me on it?

Thank you for your reply. I did file the TDIU and increase at the same time, so hopefully one or the other comes through. I was rated at 82% when I was medically retired 13 years ago. I have not attempted an increase since then and did not know about TDIU. I haven’t worked since I retired and apparently I am outside of the time limit for SSDI (I waited too long). I’m rated at 50% for GA and depression so looking to increase that as well as my orthopedic issues. Was the TDIU difficult to get?

I’m in Ohio, so unless your ortho will do a Telehealth visit I think I’m a bit too far away. The ortho I’m planning to use is doing it all remotely though so hopefully there are no issues there. I wish I had gotten advice from you guys before getting a VSO. I feel like I’m working backwards now and fighting the clock. I’ll make sure that ortho is doing a DBQ for me as well as the Nexus letter. My actual ortho here in Columbus is really nice though and may not have a problem doing the DBQ and medical review for me. I guess I should ask before paying someone out of town.

I have the TDIU claim running concurrently to the s/c increases and new knee claim. I haven’t been able to work since I got out and had no idea what TDIU even was until my husband’s VSO told me I should apply. I also didn’t know I should have done this years ago or pipe up about my left knee while I was still active. The VA did my disability claim and C&P exams a full year before my official discharge…again, I had no idea what was going on and didn’t know to ask any questions. So I’ve been paying out of pocket for surgeries and all of my healthcare because I didn’t know I was 100% covered by the VA. It’s unfortunate, but I’m thankful to be headed in the right direction now. I’m at 82% and think I can easily get to 90%, but I’d take TDIU in a heartbeat since my conditions are permanent or only getting worse.

Ok thank you for your feedback. That answers my questions and it appears it’s definitely worth my time to get the nexus letter from an orthopedic surgeon. I had an MRI in 2014 (2 years after my medical retirement) that showed grade II/III chondromalacia in that knee, so my surgeon is comfortable in stating the wear and tear began several years earlier and was certainly aggravated by running, climbing up and down ladder wells and climbing helicopters. My claim is currently entered as trying to s/c my knee just on its own. I’m already s/c for my right knee and both feet (pes planus) so I could connect my left knee as secondary to those, which it likely is anyways. Should I try to add a knee secondary to feet/right knee onto the current new knee claim in motion? I’ve not had very good VSO advisement on this and am desperately just trying to do this right the first time. Their opinion is to just try it and appeal if it doesn’t work, but this is very stressful and I have mental and behavioral health issues (also s/c) that I’m trying to work through in parallel to this claim. So in case I babbled too much and made this confusing, my basic question is will the VA take a nexus letter stating my left knee is secondary to my service connected right knee and flat feet of the claim doesn’t specifically state it’s secondary? How do I fix this? thank you again!

The disability I have is chodromalacia/osteoarthritis of my left knee. Since I left the service, that knee has continued to rapidly deteriorate. The point of showing me running with a knee brace is that I was in pain and trying to self-diagnose and treat. The onset of chondromalacia began while I was on active duty, which my understanding is the point of a nexus. Lots of veterans have rated disabilities and are not wheelchair bound, myself included. Also, it was a sprint triathlon…which is a 3k…I struggled through 2 of them before giving it up entirely due to progressive bilateral knee pain.

Hello, new here. Working through getting an increase on my s/c issues and it has been brought to my attention I should have had my left knee s/c this whole time (medically retired 12 years ago). I have photographs of me competing in triathalons while wearing a knee brace on my left knee while on active duty. Platts data with my matching bib number backs up the dates of the photographs. Is this enough for the VA to service connect or should I still get a nexus letter? I’m s/c for pes planus and right knee, so could definitely get a letter for left knee secondary to those issues, but would prefer to just submit what I have. It seems like a smoking gun, but don’t want to assume how the VA will look at this. Thank you!