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LKF050813
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Posts posted by LKF050813
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13 hours ago, pacmanx1 said:
Because you have a pending decision, it is best to wait. SMC ratings are different than regular ratings. Regular ratings go by the date you filed your claims, but SMC ratings go by the date you actually meet the criteria. So, it is possible after your pending decision, if you meet that criterion, the VA may grant it without you filing a claim.
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
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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.
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37 minutes ago, pacmanx1 said:
When the VA granted you 80%, they should have discussed TDIU in that rating because the 80% already makes you eligible for TDIU. SMC-S is about $300.00 to $500.00 extra above the 100% or TDIU pay rating.
A veteran can be awarded SMC-S if he/she is rated a single 100% schedular rating plus an addition 60% or a single TDIU rating with an additional 60%.
Total plus 60 percent, or housebound; 38 U.S.C. 1114(s). The special monthly compensation provided by 38 U.S.C. 1114(s) is payable where the veteran has a single service-connected disability rated as 100 percent and,
(1) Has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or
(2) Is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime.
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?
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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.
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13 hours ago, Lemuel said:
Yes, combined total is better than TDIU. But no, why give up what you should have had. The extra-schedular claim to the Director of Compensation Services is reviewed at the Central Office. The AOJ did not forward my claim for review and I mistakenly thought their decision, which appeared blanket at the time, was all I could get. Nothing prevents you from increasing schedular after you have TDIU. And a higher schedular helps with SMC.
Since they are two separate channels, one at the AOJ, and the other at the Central Office, and the AOJ was required to submit your case for TDIU to the Secretary even if you did not meet any of the presumptive qualifications. I suspect your TDIU will be much faster and now money is worth more than future money. It will buy more bread or gasoline.
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?
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4 minutes ago, pacmanx1 said:
The reason why I was awarded two separate increased ratings and assigned two separate TDIU ratings is because the VA failed to correctly process one of my original claims. I filed the claim around 1998 and it was denied, I then filed a NOD that got lost for two decades (20) years. It took me 20 years complaining about my lost evidence. When the BVA finally reviewed my records and granted my claim/appeal, the regional office low balled it and I filed a new NOD. The BVA finally found my NOD and granted me an unadjudicated (still open and pending) claim dated prior to my 100% schedular rating. So, with their help they back dated my awards
The only way you can get an earlier effective date, you will have to prove that you have a disability that should have been rated prior to your 100% rating. If the VA denies your TDIU rating and grant you 100% schedular. Yes, you can appeal and request a TDIU rating based on your current symptoms.
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.
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12 minutes ago, pacmanx1 said:
Some veterans do not fully understand that their effective dates are the key to when their protection period begins and when they are fully covered. My records contains all three ratings. I will give examples. These are not my actual effective dates, but my records show something like them. Because we have VA employees come to this site from time to time. I choose not to post my actual information.
So, let’s say I was originally granted 100% schedular P & T with an effective date of 2006. When the BVA granted me a new disability with a 30% increase that was not already included in my combined 100% scheduler P & T rating. This caused me to be granted a TDIU P & T rating with an effective date of 2004.
I disagreed with this decision and because the BVA directly service connected my new disability to my military service, I requested a higher rating and the BVA granted me a 50% rating in which that TDIU P & T rating gave me an even earlier effective date of 2003 which put me under the 20-year protection period. So, I have a TDIU P & T from 2003 protected. I have a TDIU P & T from 2004 protected and I have a combined 100% schedular P & T that will be protected in 2026.
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? -
4 hours ago, pacmanx1 said:
It is what it is, just keep in mind that I have been rated 100% scheduler P & T for most of this time and the two EEDs granted me two EEDs in my ratings and in my TDIU effective dates.
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.
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3 minutes ago, Lemuel said:
I did not apply until 1987. I did apply for my head injury and hope to get my epilepsy EED to 1974 when I got out of the Navy. I was having partial and complex partial seizures that were seen as me being "drifty". I could talk myself into a job because of anosognosia, I was unaware of what was happening. The VA still will not diagnose anosognosia.
I had a parttime employment from 1987 to 1990 when my state disability ran out thinking I could keep up a 20 hour per week job by putting in more hours. It did not work. The employer's statement is what was the convincing item in 2020. A 1990 BVA hearing ignored the 2nd page. It was a sheltered employment by someone who wanted to help a veteran.
The point is, the date of my extra-schedular claim was ignored and the date of my last fulltime employment was used to determine the effective date. That is why I recommend anyone who is applying for TDIU that has not been employed for more that a year or has worked only parttime apply through the extra-schedular opportunity.
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.
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4 minutes ago, pacmanx1 said:
That is what the VA did to me. I was rated 90% and had a few claims on appeal and the VA decided to grant me 100% scheduler P & T and denied my TDIU claim stating it was moot. My appeals have been running and pending for quite some time. I finally was awarded two separate EEDs back to 1998 but the VA has been fighting me all the way to the CAVC (Court of Veterans Appeals).
It is possible that with your new IMO (Independent Medical Opinion) that the VA may catch it and correct your rating percentage and effective date, just be prepared to file an appeal and fight for your benefits.
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
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18 minutes ago, Lemuel said:
My "extra-schedular TDIU" claim was paid back to the "last day of your full time employment" as recommended to Beth Murphy, Director, Compensation Services.
Redacted documents of the process are attached. No mention of anything other than employment. Note the dates of the decision and the EED.
20200406 - Admin Decision_Redacted.pdf 175.15 kB · 1 download 20200408 - TDIU Review - Admin Opinion_Redacted.pdf 146.23 kB · 1 download
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.
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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?
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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.
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2 minutes ago, pacmanx1 said:
What I mean is once all your claims and or appeals are completed, after the VA and the SSA makes their decisions, and long after you have filed your claims, just keep an eye on the dollar amount of your monthly benefits. You can look up what a 100% veteran makes and the SSA office should send you a letter of what your monthly benefits should be. The request for an audit would simply be to make sure that your retro benefits were paid correctly. This is just a heads-up and not to scare you.
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?
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18 minutes ago, pacmanx1 said:
Unfortunately, the SSA and the VA are two different animals or chains of thoughts. Typically, the SSA will only pay back, or retro pay back to two years after your last application. Meaning you will win your benefits, but you will not get paid for the entire time. Unlike the VA, VA is different as to the VA will retro pay back to the date you filed your original claim or back to the date of your discharge if you filed within a year of retirement. Either way it should really help. Now for the bad news, because you retied, I am pretty sure you may have to file an audit after all your decisions come through. Best Wishes
Thank you for the reply! Can you expound upon the last sentence? Would I be filing an audit for my original 2011 rating decision?
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On 3/27/2024 at 5:57 PM, Lemuel said:
Seaman
6
"Posted March 4
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!"
If you are not working now and you have or can get a physician's statement that you are not working because the military contributions to your disabilities are the primary reason for your not working, then you should apply for an extra-schedular TDIU. My TDIU was given to me back to the last day of my full-time employment.
Also very helpful, which I had in the record at the time I applied for extra-schedular TDIU was a part-time employer's statement about the problems he had to make allowances for to continue me in part-time employment. My part-time employment ended i 1990, My claim was in 1987 before I took the part time job thinking I might be able to keep it up by spending more hours on the job to at least bring some money into my home. My EED was back to 1985, finally granted in 2020 because the AOJ had not processed it.
It also helped that there was a Social Security "CAVES" report in my record. SS does a much better investigation and research. If you can get SS to take up your claim for SSDI or SSI you will be ahead because their physicians tell it like it is in their reports. Plus they interview past employers, friends etc. that have witnessed your disabilities in action.
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?
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On 3/23/2024 at 2:10 PM, pacmanx1 said:
You may very well be correct, but you should file a claim for SSDI to get your denial letter and then contact a reputable lawyer that deals with SSDI and the military. Many times, you should not go by what you think or what the SSA office tells you in person or over the phone. Make them give you a denial letter and then try to appeal it to a higher level. If you have done this then, I would say don't miss your retirement date.
Most veterans don't know that they can actually change their on-set date for full SSDI.
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?
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13 hours ago, john999 said:
I would concentrate on a current claim for TDIU then you can work on the 100%. The sooner you can get TDIU P&T the sooner you can quit worrying about the VA reducing your claim, or fooling around for then years on appeals for your secondary claims. You can do both a claim for an increase and a TDIU claim at the same time. When you got your medical discharge how much disability did you get? I think you can win your claims because you have evidence of disability in-service. Have you pursued a mental health claim? I would start seeing a VA shrink about depression due to your medical condition and chronic pain. I got 70% for depression along with about the same for physical conditions due to agent orange. It all goes together. Before I came to Hadit I did not know about TDIU. I had just 30% for depression. Within one year I had TDIU P&T with a years retro. You just need information and ability to deal with the VA. How long have you been unemployed and unemployable? Are you getting SSDI?
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?
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58 minutes ago, Rattler said:
The answer is yes as to a secondary to your secondary to my service connected right knee and flat feet. (I am assuming the flat feet was from combat boots) I think you might get it to go on its own but you would have a better chance as a secondary. (it's easier to prove causation that way as you have been out 12 years) That is how I got my left knee service connected due to my right knee and hips.
You will have to have him fill out this DBQ. This is to counter act the one that the C & P doc that they will send you will fill out.
KNEE AND LOWER LEG DISABILITY BENEFITS QUESTIONNAIRE
I would also cherry pick the medical records that you submit to the VA. Don't sigh the permission form or rely on it to get the right medical records in the VA's hands. Only give them the ones that relate to your knees and feet.
It is my experience that they won't read through 150 pages to find the 5 pages or more that is relevant to your claim. I would submit the MRI report. If you do this it should make you claim go quicker.Let me know what part of the country you are in. If you are near Atlanta GA I have a good working relationship with an orthopedic surgeon there that did a 13 page Independent Medical opinion and 4 DBQ's at a reasonable price. I live in AL and don't hastate to drive and see him.
Lastly I am going to send you a PM with some info as to where to go get more info as to file claims and how to.
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. -
38 minutes ago, john999 said:
Yeah, I like your chance at getting the knee connected as secondary. You know you have enough to get TDIU as is without getting 100% schedular. I had TDIU for years before I got actual 100%. Getting from 90% to 100% is very hard. You need an extra 50% to get there. VA math is a killer. I had 93% rounded down to 90%. I finally got 100% when I added an extra 80% and even then I got 98% rounded up to 100%. If you are not working just go for TDIU. Much easier!
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.
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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!
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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.
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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!
Nexus letter if I have photographic proof?
in Entitlement - Veterans Compensation Benefits Claims
Posted
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.