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VetsLady
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Posts posted by VetsLady
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Argh.....
I need to vent. VA appeal is sending me bonkers. And, why on earth do they need to be rude? At that point, I just politely say,
"Thank you for your time" and hang up.
The information they have, if they have it is not correct. This Rep told me to contact our SO....we don't have one and for many good reasons.
I know most of you have received the run-around from time to time with VA.....but why, why, why did this woman have to be rude?
My Mom always told me you catch more flies with honey than with vinegar. I'm always polite and courteous. Arghhhhh.........just needed to
vent. It's very frustrating this appeal process. Oh, and she told me "Look, these appeals take years" emphasis added on the word years.
Deliberately she placed great emphasis on one particular word. I'm thinking, ah yeah, they take years off your life.
Send me a chill please............
VetsLady
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At his BVA videocon hearing, my husband signed one of these waivers. Last November. His case may have gone for review faster had we not filed for TDIU at the mis-guided suggestion of his former SO.
Supposedly, his claim went to AMC early Sept., It's pretty clear cut claim, old (filed in 2003) and have received notice via AMC that his claim is now upstairs waiting for a rating.....rating there means a review also. I called and asked. They use terms interchangeably and for the same thing often.
I was also advised they are reviewing remands from 2006 now, but who really knows.
I feel he did the right thing signing the waiver.....our RO bucked his being in RVN for years, finally agreeing he was there and he received SC for that part of his appeal. Now, we await this 2nd part.
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We had the same experience at the local VAMC. They can bill for NSC treatment but, then my husand is 70% not 100%....it's a disgrace if the VA doesn't pay for 100%.
Did anyone see the 60 minutes segment on the Medicare billing scandal that aired last night? Unbelieveable. Medicare Madeoff's.
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Hubby received this VERY
informative phamplet enclosed with his BVA appeal decision, that was remanded.If it were only that simple.
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Vets Lady:
The Va does not call their "customers" PATIENTS for a reason. I think I am an IMPATIENT patient.
It is easier to get it to try to stop raining than it is to hurry up the VA.
It is my humble opinion that they should pay Veterans compensation with the same speed employees get their pay.
How about if you went to the market to buy a gallon of milk and just said "I'll come back later to pay you" - How long do you think it would take for them to come after you? 3 seconds. And, you'de be on video.
We've been in line since 2003 and hope we'll be getting out of line with a positive outcome very soon.
I was a calmer 8 year old waiting for school to start after long, boring summers.
VetsLady
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The IRIS we received also said the VA made my the inquiries made through IRIS a permanent part of the file for the regional
office's review and information while processing his claim.
We do the same
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FS Ross....
Not sure if this additional information helped or not. My husband's claim is very old and at the AMC - he had a videocon hearing with the BVA late last year.
If your claim is still at the VARO, I don't know if this information applies to a newer claim or not. Perhaps someone who does know will come along and let us all
know.
I wish you the best of luck in your claim and hope you will get a favorable decision very soon.
VetsLady
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Every few years it seems the VA comes up with new 'VA-ola'
For example we used to have adjudicators-now they are called rating specialists-
this sure is a new one to me-no wonder there is a backlog if there are 2 rating boards for each claim.
Actually we Used to have 'rating boards' but now it seems to boil down to just one person who rates.
But any decision needs 2 or 3 separate authorization signatures-maybe this is what they mean?
I just spoke with the AMC person who returned our call yesterday. She told me a Rating Specialist and an Adjudicator are the same.
She also told me the IRIS we received that said "Secondary Ready for Decision" meant in our case, that the claim was reviewed, it went
upstairs for a rating specialist who saw something that needed to be corrected (my guess is that it was probably the dropped issue didn't get
dropped off the system but the withdrawal was in the file and they saw that), they sent it back downstairs for the correction and now it's
back upstairs with a rating specialist who is reviewing the file (there is alot of documentation of evidence in there) and they will then rate
the claim if it's approved.
This is not in stone, but I was also told by our Congressman's office that if the file goes "upstairs" at the AMC it's a favorable decision.
My stomach is in knots, for lots of reasons aside from this, but on top of everything else, this doesn't ease my worries.
If anyone else has had this experience or can shed any additional light on the subject matter, feel free to do so. It would be more than welcome
VetsLady
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Shinseki aid in Congressional Testimony that VA processed and decide over 92000 claims last month a VA record. The heat is on to move claims
I curious about these Monday Morning Reports....
There are none available to view after 9/28/09....hmmmmm?
I printed the 9/28 and since our claim is with AMC in DC for decision rating
and I received info yesterday that they were working on claims remanded from
2006 and I'm seeing 1 claim in the rating claims pending column....?????
Makes me wonder how accurate those numbers really are.
I also thought that perphaps in our case where the IRIS said
"Secondary Ready for Decision" - that perhaps since we had 2 issues
on appeal, dropped one which left one, that decision one was dropped
so now they are moving onto decision two. As confusing as that even
sounds to me and I wrote it, it's often been how VA speak has been I've
noticed, there are so many different ways to say the same thing in VA land,
it's confusing.
And they said English is the hardest language to learn!
Any heads up on these reports would be great. I can figure a spreadsheet,
but not this one...?
VetsLady
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Vets lady: There are quite a few benefits to you/your husband. They should have classes in college on Vetrans benefits. States often have benefits for Veterans, also, to ge more on your state, go to:
http://www.hadit.com/forums/index.php?showforum=64
Thank you for the link. I'll check into these.....
VetsLady
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I just dont want you to have to have false hope.
I wish the best.
John
Thank you John. I appreciate that. False hope is not something I'm holding out for.
Hope is a constant though. Meaning that if the penny isn't in the pocket it's not there.
A good friend of mine gave me some good advise a long time ago. He said if you don't ask
for what you need or want you have a 100% chance of not getting it. He also said if you
do ask then at least it's 50/50.
This has been a very tough year for alot of people, my family included. The internet has
provided me an avenue of education and support like I've never known in my life.
Thank you to you all....I'm thankful to have found this web-site.
VetsLady
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The VA will only reimburse VA pharmacy Co-pays. They will flat refuse outside pharmacies.
J
That's what I thought too John....and, I'm sure they probably will. I'm not sure why this gentleman told me to bring the docs in, I explained they were from an outside pharmacy. We'll be there anyway for an appt, so figured no time lost. Besides, maybe it will be a nice day and a nice walk around the VAMC.....it's a beautiful location!
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We have a claim at AMC in DC and have received the same style of IRIS response....that my husband's claim is "Secondary Ready for Decision"
I sent an IRIS inquiry in to find out what this means, have yet to hear back....perhaps someone will come along and answer this for us.....
Thank you!
VetsLady
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Hi....
I had posted under another topic about the RX reimbursement. I took the advice posted and called the local VAMC. Was told to bring a copy of the last two years out of pocket co-pays (we can get it printed at Walgreens) and to bring it in (I don't recall the Dept. name, but have the bldg #) - submit the documentation and they would have to deny it and then we turn around and appeal the decision. The gentleman I spoke with said he would deny the charges that day and complete the appeal form on the spot while we're there. What happens from there I have no idea.
My husband was Cat. 1 until he was granted SC for 70% in April 08. We didn't know he was eligible for RX at VAMC as we still have private insurance and many of the meds he took were not on the VA list (we found out later and now have switched). He is now primarily receiving his medical at VAMC and all RX's since Jan. 09 when we found out about this benefit.
Submitting documentation of out of pocket co-pays to an outside pharmacy from 10/1/07 - 10/1/08 is what the gentlemen said to do. Now, since he became 70% in
April 2008, he would only be able to "consider" the charges from 4/08 - 1/09 when my husband starting receiving RC at VAMC. I'm not sure how this is going to play out and it will interesting to see as most of the meds he previously took were not available at VAMC.
It's at least worth a try. 100% chance of not receiving a possible reimbursement if we don't file it, so we will. The amount of $ for co-pays we paid was a fair amount of dough since he is on alot of medication. When he was on chemo, our out of pocket was ridiculous. Fortunately, we got 80% of that back from private insurance. Still, here we go with the lost benefits again......the issue on appeal with the VA is why he was on chemo. And, since that was more than 2 years ago I don't know if they will even consider it. I'll ask though.
We are hoping to receive a 100% rating on the appealed issue, it's a 100% ratable issue according to the CFR's. If they SC it and I'm fairly certain they will, but until the proof is in the pudding, there is no guarantee. We have a strong claim on this issue and strong Nexus letters, medrecs, etc. so keeping our fingers and toes crossed and hoping for the best.
A nurse at the VAMC told me that if my husband passes from a SC illness and it's been SC for at least 10 years at 100%, then I would receive his benefits rather than DIC.
Could someone point me to the right direction to find out what other benefits he may be entitled to? We know about the NP Pass, fishing.....but what are those hidden bennies?
Thank you.....
VetsLady
P.S. Forgot to mention....his 70% is all AO related.
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VETS Lady
You said,
"We did file for TDIU as he is eligible. Or so we thought. He filed his original VA claim in 2/03."
I recommend you put in an IRIS email, inquiring as to the status of the TDIU claim you filed in 2/03. Save a copy of their response. Reason: The VA loves to hornswaggle Vets on their effective dates. So, if you do get awarded TDIU and they make it another date, then you can point out that in an IRIS email back in 2009, you asked for a status on your 2/03 TDIU claim, and they said it was such and such. That is, they confirmed you filed in 2/03 and NOT at another date. You got to nail em, or they will nail you.
Whoops, re-reading my post, I left out one critical piece of info. The TDIU claim was denied. His SC all relates to DM2. When SSA reviewed his claim, they chose his shoulder surgery which would prevent him from working for at least one year. Because with SSA, they say you are 100% disabled or not at all. Why they chose the shoulder is (or so we were told) it was closest to the last date he worked.
Nueropathy is so severe his feet are numb up to the ankles with nueropathy in the hands as well, loss of strength (he needed strength for his occupation). When I mentioned this to his SO she suggested we file for the TDIU. We had no idea of what SSA had actually disabled him for as any of the 3 issues he filed under would have totally disabled him from the type of occupation he had. It just so happened they chose the shoulder.
QTC examiner for the TDIU wrote that his condition had not changed since he was 1st examined in 2/08 for the DM2. It has changed tremendously, his DM2 doc states so, but when it comes to putting fires out, the biggest one now is the appeal. We'll move forward from there.
In my hubby's case, SSD approval came before VA Disability was approved. About 2 years before.
One foot in front of the other.....
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First of all.....thank you for all of the input. It's a daily learning process for certain.
Ok, here is additional information I've received......
Called local VAMC, spoke with Fee Service Dept. (I believe that was the Dept.) I explained the situation we have and he told me I can bring in the past 2 years of
co-pay out of pocket expenses we had for my husband's outside pharmacy. He said that he will have to deny it initially and that we appeal the situation directly to him, he offered to assist us in completing the appeal form for this. I didn't feel I was getting the door slammed in my face at all. The gentleman I spoke with was very cordial and said he would do what he could and was definetly worth trying. At least to get the RX's the VA has on their formulary reimbursed would be great. We are by all means not wealthy people, however the amount of $ we have spent on medications for his SC illness and the issue we still have on appeal would go a long, long way.
My husband started getting RX from the VA 1/9/09. His effective date for 70%, any percent for that matter, was 4/08. So, I'm to bring in a readout from our local Walgreen's pharmacy of all charges for RX from 10/1/07 - 10/1/09. We had no idea he was eligible for RX at the VA after being SC because we still had insurance it never occurred he could. We'll take it in when he picks up his orthotics in a few weeks.
We did file for TDIU as he is eligible. Or so we thought. He filed his original VA claim in 2/03. Stopped working due to the need for shoulder surgery and a host of other issues that prevented him from performing his occupation. We submitted all of his medical documentation to SSA and they disabled him for the shoulders, not that either of the other two issues weren't enough to disable him however, he was having shoulder surgery that would take longer than a year to recover from and nothing on his VA claim was SC yet.....so, SSA picked the dx closest to the date of he stopped working. The shoulder. No claim for the shoulder with the VA, it's not service related.
Hence, you must be SC going either way on the track at the TDIU rates and that SC coincides with SSD and in the reverse as well. That's a bit confusing so I'll explain......you have SC for at least 70% (you can look at the CFR's for the rules of how they rate and how a bilateral factor figures in) - you apply for SSD for the same dx you are SC for that brought you to 70% and you are going to be granted TDIU. If you are SSD first, and in our case he has 3 major issues he was dx'd with and as I mentioned any of those 3 would have granted him SSD....it just happens that the SC illnesses and the SSD issue are two different dx and TDIU does not apply in our situation.
I took the ill advised advice of our former SO and applied for TDIU 1 month prior to a BVA videocon. You read it right. Former VSO that will remain un-named as they may have helped others.....and, now that I look back on the entire claim process we've never had good reps on his claim. The 1st one had my husband file for everything little thing, every big thing...all of this while he was on chemo and brain fried. I was there too, but a greenie and didn't know what to expect. I thought we were being taken care of. Not. Now, I've learned an awful lot over the past couple of years but am wide open to learning more. And, helping others get through the tough times and always, always to help a Veteran.
Fast forward now to the present......no VSO, we resigned their POA effective the day he was denied the TDIU. You see, while the VA told us they would be opening a second claim for the TDIU while the appealed issues were being reviewed that is not what happened or necessarily the way it goes. They worked the TDIU claim and after it was denied, the appealed issue moved forward. We are awaiting a decision, actually for a rating for a SC illness that will never get better, he's had alot of tx for it and it's progressed to the point now of no tx being available. The SC box has not yet been checked by VA but, I feel and so do our advisors that he will be SC. He has a very strong case, 2 strong Nexus letters, 1 of those from the QTC doc he saw, complications keep cropping up from the illness and he's never been the same man since his 1st chemo. This is a serious illness and will never get better, only worse. We choose however to not allow the illness to rule us - we just roll with the waves. And, being realists, we don't count a penny until it's in our pocket.
So....wish us luck on getting that 100% SC as it's going to provide a sense of security for us now and for later.
Some may wonder why I'm not working....I worked with him in our own business for many years. Now, he is my #1 priority and I'm his primary caregiver. I'm unable to work because he can't be left alone for long.
20 years together and he still gets to me......
He is my hero.
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Probably. It would not surprise me.
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Ok, now the recorded message is back to saying "Sorry we can't find your file"
What's up with that?
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Congratulations!
Your right, this is a gruely task and if you're organized and have the evidence organized, it's much easier process.
I already had his medrecs for the VA claim, so we just got them updated to the date he stopped working.
We submitted on behalf of my husband in 1/06 and he was approved 1s time around as well. We were surprised,
no wait, shocked when we received the grant letter in 4/06.
I spent the time gathering up his medrecs, organized them into individual sections for each doctor, title page, cover
page, etc. And, I dropped his claim off at the local SSA the day of his surgery.
He received one phone call interview and the award letter came in April 06. And, a check in June.
Congratulations once again!
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Am I reading what I think I'm reading?
My hubby is 70% SC. Wow, a ton of med co-pays until we found out he had free RX at the VA. He was SC in 4/08 and we started using VAMC for RX in the early part of this year. How far back can we go? Over the past 2 years, we had so much medical expenses that were not covered, (I'm including myself) it was ridiculous. Doesn't sound like we are eligible at this time for me, but is he? What form do we need to submit and what documentation? I can print off a copy of the costs directly from our pharmacy.
Thank you...
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My guess, or better yet, woman's intuition, whatever you want to call it.....
is that "something" has occurred with his claim or the call center would not have
reverted back to the message I heard.
For several, several months we've have always received the "Can't access your records, claims, hold on for
the next available rep......" message.
Now, we're hearing a message telling us what his current DD is from VA and what date his last deposit was?
Doesn't make any sense, except something has changed, not sure what and we'll know soon enough.
Was picking brains but realy can only be a few different things. Granted, retro on the way, Denied SSOC,
on it's way to BVA for final ok.
I'm sure we'll find out soon enough.
Thanks for the inputs and thoughts.
VetsLady
P.S.
If they do grant, do they send a separate check or do they DD since that is already set-up?
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Hi John....
Thanks for the input. Not to put words into your response, but.....are you thinking the appeal was granting prompting an increase? Thus, would explain the new message on voice activated 1-800 dial-it.
This has been gnawing at me all day like a mosquito bite....Deet is out of the question because of the chemicals.
I'm beginning to think I'm an impatient woman when in reality, I have tons.
Even if we call the 1800-dial-an-it on Monday, they aren't going to give us any credible info. Will dial AMC directly or, check out the the old bank account.
Seriously, as you all know, the waiting game is absolutely agonizing, especially after working the file for so many years and on top of it all, and really the most important
issue is my husband's health.
See ya all on Monday!
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I just posted a congrats to your message on attaining status of SO and here, you post one to me.
We teach best what we most need to learn. Relaxing, Waiting and if it's meant to be, it shall. If not, then we're onto the
next chapter.
Thanks for the post Larry.
VetsLady
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Mazel Tov Larry!
May God continue to shine the light of your service upon those who you can assist!
I'm certain this will be a very rewarding experience, a true Mitzvah.
Thank you......
VetsLady
informative phamplet enclosed with his BVA appeal decision, that was remanded.
Sos - Need A Chill Pill!
in Appealing Your Veterans Compensation Disability Claims NOD, DRO, BVA, USCAVC
Posted
Thanks Carlie. I needed that. Mine was getting empty.
Maybe my politeness rubbed off on her. I hope so.
Thanks again for the vent.......
VetsLady