VetsLady

This is the last IRIS we received..... Since your file is not in our office we are unable to provide you with that information. Sent an inquiry to the BVAOmbudsman....they gave me a phone number to call for info. I called. They took a message. Don't want to be a pest, but I would like to know what is going on. His SC% hasn't changed in the 1-800 dept so that tells me nothing is done yet, it's still in the process. I'm sure it takes some time for the systems to catch up with each other. We dropped AmLeg a couple of months ago. Too many staff changes to even count. I think we'll give it another couple of days and then call. Perhaps by then some additional claims movement will have been done. BTW, I was told that "decision" and "rating" are one and the same at the AMC. Seemed odd but I left it alone.

Hubby has a claim that was remanded back in March 09 for further development. Further development is done. AMC now has the claim and we are told it went to rating/decision on 9/10/09. Is there any reason why we can't call AMC to inquire as to the status of the claim? Don't want to step on toes, irritate anyone there and definetly want to keep a sharp eye on this. I received conflicting information elsewhere that AMC makes the decision then sends it on to BVA for final approval. Then, from another source, I'm advised that AMC will either approve or deny and should they approve, they will be the division that rates the claim. These were both from 1-800, who I know don't have the up-to-date info in their systems. I'd like to call the AMC directly - ideas? Thank-you.... VetsLady

Oh am sure of that Carlie. Hurry up and wait.

Thanks for the replies.... No, I haven't requested the actual transcript. We did receive the remand. The 1 issue still on appeal, the VLJ had nothing in the remand regarding it specifically. He wanted the SSD records associated with the file as VA w wasn't aware he was on SSD. We had a (yes had) a very poor VSO, which didn't help things along at all. There were 4 requests in the remand itself, 1 - for the SSD records, 2 -a QTC exam be done re: PTSD 3 - stressor verfication 4 - Readjudicate the Claim after the above is done, if not granted then provide an SSOC, etc and so on. We dropped the PTSD issue as he does not have and has not been treated for PTSD, has been examined many times, it's a depression issue related to his SC conditions and the remaining issue on remand. The VLJ saw the proof in the pudding sitting in front of him during the hearing. That, with the 2 strong Nexus and medrecs to substantiate the condition should be enough. Yes, 1 - something happened to him in service to cause an injury/disease. Yes, 2 docs (1 from QTC) say that the in-service event was the reason that caused his injury/disease. The 3 elements required are there, it's just the waiting and they lost his file, his file is so large, how could they? No one wanted to do anything on it, VSO forgot about us, didn't return calls...so we went a different direction. Seriously, if I knew then what I know now, I would have never given a VSO POA. They got their dough almost 8 years ago, and in those 8 years, he has gone down hill, 3 phases of chemo, a bunch of other stuff is cropping up, he had to quit work and the $ we have spent on meds, geeeez. We had no idea he had the med available at VA until earlier this year. So, went from 4/08 - 12/08 out of pocket, with private med ins., but still, very expensive and could not drop it or change in any way for fear of not getting onto another plan. Pre-existing condition thing. I feel he has a strong claim, but until the pennies are in the pockets, we don't feel comfy cozy. When this part is over, we'll have increases to go for on what he is already SC for. It's sad to watch him deteriorate. Enough about this.... Does anyone know how long a file can stay at the AMC for decision? What happened to expediting claims? VLJ mentioned it should be expedited in the remand. Thought there was some time frame, but perhaps appeals are on a different boat. Can't believe they would have anything else to "develop" - they have it all. I made sure of that, sent via Certified Mail/RRR.

If a Vet becomes 100% P%T, can he go back and put in for reimbursement of out of pocket medical expenses for he and his family to the date that he became 100%? Where can I get more information on this? Also, does someone know where in the docket the AMC is at in deciding claims? I know many of you have appeals at the BVA and/or AMC. My husband's was remanded back to the RO, then we dropped one of the issues and there is only 1 issue on appeal presently. We know for certain (well, haven't actually "seen" the file there with our own eyes) I'm getting conflicting information on a docket date. His file was sent to BVA in Sept. 08, hearing was Nov. 08, remand date is March 09. I sent an inquiry in to AMC and no response. Just sent an IRIS, maybe they know. Trying to gauge a timeline of when his claim may be decided as his claim is marked Hardship. I was given information that his file is in the developing dept. - all developing has been done already - but this is the last info I have. I'm told that if it goes well in development and is SC then his file will be walked upstairs for a rating, AMC is doing the rating. BVA doesn't want to see this file back as the RO really mucked it up. Thank you for any information you can provide. VetsLady

Latest.... The AMC in DC has the C-file. The tell us it's in the hands of the "developers" We are told if it gets SC, then the file will go "upstairs" to receive a rating % Since the initiation of this claim, the medical condition has on appeal has many ups and downs, was on chemo 3 times. The condition is worse now, will never get better. Might stay the same, but doubtful. However, we remain hopeful it stays the same and we remain realistic at the same time. Hard thing to do...! We are getting info to check back again in 8 weeks on the "developing" of the claim. BVA hearing was in Nov. We are told the new docket date is March 2009 so that is where we step back into line for a decision. We are told that the file being in the "developers" dept is a could be a good thing as it means "something" is being done on the file. There is no other development to be done as QTC exam was done, MD said "more likely than not" related to in-service occurence, private MD said the same thing, they have all of the medrecs up to date. Can't imagine what they need to develop so hoping it goes quickly to a SC win and then upstairs for a rating %. Not watching the mail, not watching the water boil. Just back in line for now. Any ideas or thoughts are welcome.

Hi Berta... Good Morning. Yes, I did just that, yesterday. Sent the inquiry to the AMC inquiry email address since that's where the claim is supposedly at. If I don't get a response by Monday, I will send 2, 1 to the AMC and 1 to the BVA. What the heck, may as just send 1 to the BVA address now. Won't hurt. Thanks...

Interestingly enough, filed for SSD Jan 05, approved, no question about it 1st time in and began June 05. Some say it's harder to get SSD than VA Disability. Things that make ya go hmmmmmmmm?

Forgot to mention.....Philly, Seattle, Nashville and off the top of my head I don't recall, were the 4 VARO's that are in the pilot program the VA set up to expedisouly handle claims....perhaps that's why Philly has your file. I do know that Nashville had ours, as I mentioned, they were 1 of the VARO's who had an affiliate AMC set-up to help with the overload. We are positive people and look at the glass as half full. However, until the penny is in our pocket, we'll believe it. Never imagined the TDIU would fail. But, after reading the SOC, can see why plus, it only held up the Appeal. Wrong choice to file TDIU at that time. SO suggested it and what did we know? I can say with certainty, much more now. Even going back to the original claim issues.....same SO had us list everything on the claim, right down to a hangnail, ridiculous. Stick to the main issues and the rest will follow, at least in our case that is how it should have gone. Can't change the past. No control on the future. Hold onto what you know today. Thanks again....

Hit the wrong button. Whoops. My apologies... Berta... Thanks for the reply. We have 1 issue in appeal. BVA hearing was last Nov. Filed TDIU which halted action at BVA. TDIU denied. BVA remanded issues continued on. They had remanded it to AMC-DC for further development. AMC-DC sent it to Nashville, where a team of AMC was assisting with the backlog. From what I understand, there are 4 VARO's with this special set-up. We had 2 issues originally on appeal, dropped 1 for good reason, continued on with 1, C&P exam was ordered in the remand for the issue we ultimately dropped. Now, since there is only 1 issue on the table, from what we are advised, it may go fairly quickly. As you know, many things factor into what "quickly" means to the VA. We have an old claim. Originally filed in 2/03 for 3 main issues. Nodded, DRO'ed, De-Novo Review, filed appeal, docket date on appeal is Jan. 05, April '08 awarded 70% on 1 AO related issue, ED 1 year prior. Fast forward to present....dropped the 2nd issue that was remanded for a C&P, and have just the last 1 on the table. Nashville was handling the further development issues. Since this is a moot subject, the file is now back at the AMC-DC and "ready for rating" aka: back in line. I know they are suppose to use the original docket date on the appeal as they received the appeal Jan. 05. We now have an accepted hardship attached to the claim file and IMO, a cut and dry issue that is still on appeal. I'm not the one with the file in front of me. However, VLJ was quite surprised this portion of the claim was denied and ended up at BVA. Local VARO screwed up the SSOC so bad, had I known then what I know now, I would have asked for an in-person review at their office while awaiting a hearing date. Of course, we are notifed in Oct. 08 that the hearing was on the docket for Nov. 08. This remaining issue was denied by local in August 08..... The local VARO had medrecs through mid 04 only and a very underdeveloped claim so no wonder it was denied. An in-person hearing would have cleared it all up, I truly believe that. Now, they have everything, all medrecs, 2 Nexus, the QTC doc who did the exam for this issue last year gave a Nexus, buddy statments on file, we have photographs on file, you name it, we sent it. And, dropped the SO who was assisting (not). I was just "a-wondering" if anyone out there had any idea where a VetsLady could find out where they are on the docket, without IRIS'ing or calling. They really don't give you much info at this point in a claim anyway. Thanks for listening (well, reading!) VetsLady

Hello everyone... We have an appeal I'm told is in the "rating" phase at the AMC in DC. Have been told that this phase is basically a point of jumping back in line to have your claim reviewed. We have an original docket date from Jan. 05, wondering if anyone knows where we can find out where the BVA is in the docket? Does AMC render the decision, send it back to BVA, then if SC, back to rating for SC%??? What is the order? Rating to me seems like it should be rating but, it's apparently not with the AMC. Thank you's......

I failed VA math. He needs 60 SC for the issue on appeal+1 of his current 20's (take the two highest)=80 adding in 3 more 20's and 3 10's puts him at 96+ which equals 100% Good news tho, the file is at the AMC and they are inputting the information which means it doesn't have to go back to the BVA. The good news is that they have the file. The rest, well time will tell.

Should mention also that the issue on appeal is not for PTSD as that is off the table at our request, call it an issue of character or whatever, but he really doesn't recall the stressor, it was verified from we are told, he's never treated for PTSD, and it's not, at least for him a PTSD issue. Remand was was to have the SSD records associated with the file, to verify the stressor and examine the Veteran for PTSD. There are 2 issues on appeal, and now just 1.

Didn't mean to hit the quote button, excuse me on that whoopsie. Original file date was 2/03, granted AO related SC hence SC date is one year prior to filing the original claim. Our of the service a long time ago, so no one year after discharge rule applies here. SSD applied for 1/06 granted 1st time in, ED 6/06. Claim for SC with VA is still ongoing at that point, and, at that point his appeal had already been filed. We filed for a DRO review at the RO level just a year shy of the original file date. Denied again. Then the SC comes in 4/08 - with a hand on the shoulder from our local Congressman, it took from 2/04 - 4/08 - over two years to prove DH stepped foot in Vietnam. Ok, so that part is over and done with and at a later date, we'll file for EED as they gave him a pittance of a % up until the date QTC doctor saw him, thats when he rec'd the 70%. So, for the time being, we put that aside. The current issue on appeal is what we're dealing with now. Just prior to his hearing date in Nov.08, said SO (and I will not name them as there may be some Vets getting a fair shake with them) suggests he file for TDIU. He files in Oct., Heaing is in Nov., Appeal is remanded for further development on a PTSD issue of which since it was on his original claim, and no one had addressed it, the VLJ felt it needed addressing and rightfully so. VA was ordered to verify the in-service claimed stressor that my spouse didn't have any recollection of until talking with a buddy of his years later and he has never had a dx of PTSD, possible PTSD, but not definetive. Again, at the initiation of the claim in '03, said SO told us greenies to list every little ache and pain you may have rather than concentrating on 2 main illnesses/disease as all the other issues were symptoms and would fall under the 2 illnessess/disease.... Filing a TDIU claim just prior to a BVA hearing was not a smart thing to do, we live, we learn. He was denied TDIU because his SC was not what SSA disabled him for, although it was on his app, SSA disabled him 100% for the non- SC condition. Fair enough. Had he only had the 1 condition and not the other, SSA would have approved him forthright anyway, and VA would have denied him as it had not been SC when the TDIU claim was filed. TDIU is history now. Should they SC him for the current issue on appeal, even at 30% (it should be higher), adding math the way VA does, he'll start with 50, (20+30) add 20, add another 20, then 3 10's and he'll be at 100% I understand their rating schedule. Take the 1st 2 highest, add them together, then go from there. My questions were answered by this forum, we'll have to wait and see what happens on the ED. If they go back to the original file date or use the SSD date, it's a complicated issues yet very simple. Some periods he would fit into a 100% disabling period of almost 1 year, then to a 50 then back to 100 and this went on over the course of 4 years. We are advised that his original claim "fell through the cracks" - think about this, he files in 2/03, denied, filed for a DRO at the suggestion of his SO, denied. File a formal appeal when the DRO is denied. All with not one exam from VA having been performed. Now, we know why. Ultimately it's the Vets responsibility to make sure everything he/she wants considered is in the file, don't rely on your SO to give you a call or send a letter to you to submit additional evidence. DH's claim was SC in 4/08 based upon medrecs that were in the file (through mid 04)and the QTC exam from 2/08. You can be assured they have it all now, as I made absolutely certain they had all they needed to make an informed and accurate decision. Any Veteran can have any SO rep them, but still, it's up to the Veteran to provide all of the information VA needs to make a qualified determination of the claim. I truly believe (but can't go back in time) that had they had all of this current info we would not have had to go in front of the board to prove his claim. BTW, we waited for well over 2 years for that to happen. I sincerely hope we won't need to go the CAVC route, but will if needed. All of this from 1 clerical mistake by 1 RO who made a wrong decision and didn't know their left from their right, literally. Thanks again for the insight.

vaf, Thx for explanation. Yes, I am aware of how the claim process is suppose to be. If they do SC for whatever %, we will take that and file reconsideration for EED or higher %. His disease will never get better and their is no medication that can make it any better. Unfortunately, it is what it is. The docs tried 3 times to treat, none of which worked and his condition has only worsened with new manifestations and residuals pertaining to the disease cropping up here and there. We accept it and move forward. I'll send another IRIS this evening and perhaps when "IRIS" gets to the office, she/he will respond that his file is there. They told me last Friday it was headed to DC, but would prefer to confirm it did arrive. Intact and in totality. Thx for the words of advice. Wouldn't it be grand if I picked up our mail tomorrow and AMC decision with SC is in there.....whoo-hoo, that would be a postiive note. VLJ saw during the hearing where the VARO clearly made an error in their SSOC issued on the appealed matter last year. It's not really a CUE, but certainly was on the line and in the grey area. One thing I am curious about, do they go all the way back to day 1 for an ED? Or, do they go to the date of the QTC exam? Or to the date he was eligible for SSD? Part of the reason he was SSD was this disease but SSA picked the one that would prevent him from doing what he did and that was primary even though we had the other conditions listed. What he is already SC for is an AO issue so retro went back to 1 year prior to filing the original claim. % was incorrect but planned to go back in and argue that after the appeal decision came back. Should mention, he was one sick puppy when we filed, medrecs verify that. He didn't have an exam until 8/08 when he was already pst the point of treatment and doc gave a Nexus opinion of more likely than not, same with his private med doc. We'll see what happens and go from there.

Thanks vaf, I thought this was the way it would go. So, the SOC is sent out to the Vet when the claim folder is sent back to the BVA? If so, it's probably at the Post Office with the rest of our mail from the past week since IRIS inquiry stated AMC sent sent the claim folder to BVA on 9/2. Thx, VetsLady

Berta, Did not see your reply prior to my reply to John, thanks John. IU isn't the issue here at all. We did file a TDIU last Oct and were denied, as the SSD determined IU was not in relation to a SC condition. At BVA, there is 1 issue on appeal, cut and dry. Three Components are present: Present disease-injury/related to in-service occurence/2 Nexus letters relating current disease/injury to service, 1 of those from a QTC doc, 1 from Vets private MD. A stack of medrecs VA didn't have when they made the determination of the claim in April 08, awarding him 70%. The final issue is the clencher. VA made decision on records they had through mid 04 only, even with the 70% SC. They have everything now, up to date and always sent CM/RR. SO was never ever available, but that is in the past and we are in the present so it's a moot subject with the SO. Their POA was revoked after the hearing and the file has moved along a little fast than a snail's pace since, which is to say it's faster than with the SO we had! Thanks for answering my question....

Yes, but SSD disabled him for a non-SC condition few years ago. IU is not what we're going for. It's a case of 100% schedular rather than trying for the bits and pieces to get to 100%. That would never happen. You can have a whole sling of 10's, enough for a pretty little necklace and still won't get to 100%, so we are going for the 100% SC on this final issue. Definetly meets all the criteria, without a doubt. The entire original claim was denied, appealed, re-reviewed for the 70%, granted at RO level, the rest of it, (1 issue) went to BVA, hearing occurred, remand to AMC, file went back to AMC DC on 9/2 per IRIS inquiry. I appreciate your thoughts.....I'm trying to find out who makes the decision on the issue that was appealed? Is it that AMC makes a recommendation to BVA based on the evidence and on any additional evidence the VLJ asked for, and sends the file back to DC for final decision. I may have not listed my question specifically. My apology. Does anyone know who does make that final decision? We waived rights for RO's to readjudicate as the claim is moving into the old stack at BVA and was pretty clear the original RO couldn't tell their right from their left. Long story...... Thanks.

Hi, Can anyone tell me why AMC is returning a remanded claim (all development was completed) to DC? Who does make the decision? From what I have read, it seems like the AMC makes a recommendation to the BVA and BVA will concur or deny. Either way, can the BVA can reverse the decision? We don't know what the decision is yet, if any. Will that actually come from AMC via snail mail or BVA? BTW, we self-rep and plan to keep it that way. Last SO did nothing for the claim. Claim was awarded 70% in April 08, but still had one other issue on appeal that went the whole nine yards to BVA. We are going in to the 7th year of this claim. Thoughts appreciated.

How many signatures do you need on a TDIU claim decision?

Have received several of these spit out of the pc letters, however, none received this month. You know the ones, every 60 days, blah, blah...doing all we can to process you claim, etc. and so forth. I wonder, wonder, wonder if possibly since this months "letter" didn't arrive when scheduled, and DH's TDIU claim will be 60 days and counting on 6/23, if VARO is finally getting around to rating it. It's been there since 4/24/09 per IRIS and 1-800, filed the darn thing last October. Reluctantly we have had to keep the VSO on board as there is a pending decision at BVA also, the VA did set up a temp file for the TDIU. If I had enough energy to post what VSO said, I would.....lets just say they don't know how to count. Reps says, oh they don't count weekends when counting out the days, they only count business days a claim is in the pot getting stirred. When I was the heavy hearted soul who worked for an attorney who had a contract processing foreclosures on VA home mortgages (in the 80's), they sure counted the weekends for those who were losing their homes. Interesting..... Thoughts???????? VetsLady

Where did you obtain the form to request SS regarding primary and secondary disabling conditions? We were advised it would take 6-8 months to research. Really think that SSA just didn't want to bother. He has SSD since 2006 - filed for TDIU about 8 months ago, no word yet except the usual every 60 day form letters.