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Rhodesia

First Class Petty Officer
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Everything posted by Rhodesia

  1. Optional Documents 11/30/2018 Please submit any supporting documents. Include any documents that we requested when you submitted your application for this claim. To see all uploaded documents associated to this claim, select the "All Uploaded Documents for this Claim" tab above. Note: Supporting documents uploaded before January 26, 2015 are not displayed. Upload Documents Request 1 Due Date: Not available Status: No Longer Needed DBQ MUSC Knee & lower leg Request 2 Due Date: Not available Status: No Longer Needed DBQ DERM Scars Disfigurement Request 3 Due Date: Not available Status: No Longer Needed Exam Request - Processing now my claim says this? Optional Documents 11/30/2018 Please submit any supporting documents. Include any documents that we requested when you submitted your application for this claim. To see all uploaded documents associated to this claim, select the "All Uploaded Documents for this Claim" tab above. Note: Supporting documents uploaded before January 26, 2015 are not displayed. Upload Documents Request 1 Due Date: Not available Status: No Longer Needed DBQ MUSC Knee & lower leg Request 2 Due Date: Not available Status: No Longer Needed DBQ DERM Scars Disfigurement Request 3 Due Date: Not available Status: No Longer Needed Exam Request - Processing
  2. Here is what was re-submitted AGAIN to the VA. Status of Your Claim GATHERING OF EVIDENCE Submitted: 11/15/2018 (Compensation) Estimated Completion: 01/25/2019 - 03/16/2019 Disabilities Claimed: post operative surgical scarring due to service connected left knee surgery in June 2018 scar is 15 inches long and 1/2 inches wide raised painful limits range of motion (Increase), reconsider left knee temp total (Increase) due to 2nd total left knee replacement Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS Current Status: Gathering of Evidence
  3. I saw the VSO rep and she did say that somewhere along the line I was suppose to go to a C&P exam in order to have the second total knee replacement approved in another words their approval, then after the surgery go back to another C&P exam in order to be approved for the 100% temp. She did tell me that she has been seeing allot of these because the VA is trying to only let you get one 100% temp no matter how many times you have surgery on your service connected injury, she said she has seen most of these complaints go to their congressman to file a congressional. She said the "Reasons and Bases" was that I supposed to have missed the evaluation appointments before the VA would give their approval to have the second knee replacement first before having the surgery, problem was I was never contacted so she sent out a claim form to let them know to reconsider so I can be seen and hopefully get the 100% temp. Also I can see that they only received half of the medical documentation at that time I guess Janesville failed to upload and file half of my claim but everything I uploaded is on e-benefits. She also told me that if I receive any letter from the VA stating I have to pay them back for the total knee replacement because I did not get their approval from the evaluation C&P exam prior to the surgery to let her know as soon as possible. I also filed a separate claim for "Post Surgery Scars" for my left knee the scar after the surgery is 15 inches long 1/2 inches wide with pain mostly in the middle and since June 4th it feels like it still not healing because at times it has been bleeding on the inside so she added all that in the claim for scars from the surgery. Tri West gave me an extension up until March 30 2019 in case I have anymore medical issues with my knee. Interesting because I never been through this with my first total knee replacement, now it looks like I have to have a C&P exam in order to get the surgery and approval for the 100% temp, she said is worse case they can still deny my 100% temp.
  4. I don't know what the VA thinking is but I was denied the 100% Temp for my 2nd total knee replacement on the same knee which is service connected, the VA states I did not meet 38 CFR 4.30 and in big block letters on the letter that I just received even through it was dated Oct 29th 2018 it says 'Your claim for 100 % temp for the total knee replacement for a service connected injury is hereby DENIED' and it does states that. It also goes on to say that while in the process of having the knee replacement I failed to meet a VA certified doctor appointments (I never received any letters or phone calls on this issue) to evaluate why I need the second knee replacement before the surgery but the funny thing is the VA approved it an so did the VA doctor That I see once a year at the VA before I had it done on the outside because of the choice care program. The letter also says that is also the reason why I was denied. What the hell is their thinking because I did not have to go through this mess on my first knee replacement at all. The last part of the letter does states that since I did not meet 38 CFR 4.30 and failed to meet with a VA certified Doctor before and after the care I may be subject to paying the VA back for all expenses for the total knee replacement. The letter does go on to say that the VA has made some major changes in how they meet the needs of the veterans under some new law that was passed. I could not find a thing on that issue. I was sent out in town BY THE VA under the choice care program and Tri West the carrier that is contracted by the VA to pay for the surgery and the Doctor was the only one on the list because he was the only orthro Doctor that would except payment form the VA because the other orthro doctors in the city would not even touch me because they have had NON PAYMENT problems from the VA. I'm in the process in seeing what my VA rep to see what she can do, but she seems to be gun shy on even trying to pursue this issue. I did receive all the VA standard forms in the letter packet to file a NOD or paperwork for an appeal but these take up to 1 to two years to process. I will keep you all posted on what course she will take, I hope I don't hear the words I can't help you on this issue I don't know if it would be in my best interest to re-file this all over again as a new claim again.
  5. Thanks I will give that a try after I see what was written, The VSO said she was going to push the complaint and the head VSO in the office was going to elevate it with a few calls. I think the VA can use some customer service training. No wonder us Combat veterans always has negative impressions I get better care in the private sector than I do at the VA hospital, sorry to say that but in reality it's true.
  6. I saw the The VSO I'm working with Monday and told her what I was told so she called and was told the same thing. she could not read the letter at the time she has the ability to do that even before I receive it in the mail. The letter was completed on Friday 10/26/2018 and the letter was sent on Friday plus they hung up on her when she was trying to challenge her why I was denied the 100% temp for a service connected total knee replacement which was my second one on the same knee. The VSO was trying to explain to her that she never heard that a Vet is only entitled to 1 100% Temp for a service connected injury. I was in the office listening in on the speaker phone, she sounded very nasty and hung up on her before she could finish her sentence. The sad part is the person on the other line for the 1-800 number never gives you their last name or call center, which there only thee call centers in the united states for the 1-800 number. I just have to wait until the letter comes in the mail explaining why I was denied the 100% temp which would have been for the 13 month Temp, sad part is I'm still going through therapy for the knee I was granted 7 more additional weeks and the VA approved it through Tri West. and I had the Total Knee Replacement on June 4th 2018. If anyone out there has had this problem before please let me know how you handled it.
  7. I found out that I will not be receiving the 100% temp for my 2nd total knee replacement on the same knee, the person on the other end of the 1-800 could only tell me that the VA says I'm not entitled to a 2nd 100% temp claim you only get 1 100% temp claim per service connected injury no matter how many times you have surgery on that same injury, they also told me that the CFR will explain why I was denied. I find that really odd, but I was told I would have to wait and read the letter that the VA sent out explaining why I was turned down and their opinion. They could not tell me anything more and if I wish I could see my VSO and file a NOD for the denied claim. This whole claim has taken a wrong turn in the wrong direction. So as of right now I remain at 40%. with a whole new knee for the second time again, interesting how the VA can find some way not to pay when everyone says you are entitled to the 100% Temp including the VSO. Status of Your Claim COMPLETE Submitted: 08/01/2018 (Compensation) Claim Closed: 10/26/2018 Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New) Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS Current Status: Complete
  8. I found out that I will not be receiving the 100% temp for my 2nd total knee replacement on the same knee, the person on the other end of the 1-800 could only tell me that the VA says I'm not entitled to a 2nd 100% temp claim you only get 1 100% temp claim per service connected injury no matter how many times you have surgery on that same injury, they also told me that the CFR will explain why I was denied. I find that really odd, but I was told I would have to wait and read the letter that the VA sent out explaining why I was turned down and their opinion. They could not tell me anything more and if I wish I could see my VSO and file a NOD for the denied claim. This whole claim has taken a wrong turn in the wrong direction. So as of right now I remain at 40%. Status of Your Claim COMPLETE Submitted: 08/01/2018 (Compensation) Claim Closed: 10/26/2018 Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New) Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS Current Status: Complete
  9. I found out that I will not be receiving the 100% temp for my 2nd total knee replacement on the same knee, the person on the other end of the 1-800 could only tell me that the VA says I'm not entitled to a 2nd 100% temp claim you only get 1 100% temp claim per service connected injury no matter how many times you have surgery on that same injury, they also told me that the CFR will explain why I was denied. I find that really odd, but I was told I would have to wait and read the letter that the VA sent out explaining why I was turned down and their opinion. They could not tell me anything more and if I wish I could see my VSO and file a NOD for the denied claim. This whole claim has taken a wrong turn in the wrong direction. So as of right now I remain at 40%.

     

    Status of Your Claim

    COMPLETE

    • Submitted: 08/01/2018 (Compensation)
    • Claim Closed: 10/26/2018
    • Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New)
    • Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS
    • Current Status: Complete
  10. Here is what was showing this morning on ebenefits Never seen this during my first total knee replacement, so I have a funny feeling that I'm not getting the 100% temp for my 2nd total knee replacement. Status of Your Claim PREPARATION FOR NOTIFICATION Submitted: 08/01/2018 (Compensation) Estimated Completion: 10/29/2018 - 10/31/2018 Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New) Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS Current Status: Preparation for Notification
  11. Well just now this claim has changed to this status "Pending Decision Approval" but not really counting on this because last time it change back to gathering of evidence status. Hopfully they will retro back pay the 100% temp My surgery was on June 4th 2018 My original claim started on April 15th 2018 and final documents were filed on June 5th 2018 but my claim two months later was lost for some unknown reason so thats why I had to re file on August 1st 2018 and start the process all over again. I called the 1-800 number just to ask the question would I receive retro back pay for the 100% temp, the young lady said she could not answer that. All she could say is that it is in the Decision Approval phase. So It's a hurry up and wait. Status of Your Claim PENDING DECISION APPROVAL Submitted: 08/01/2018 (Compensation) Estimated Completion: 11/01/2018 - 11/05/2018 Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New) Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS Current Status: Pending Decision Approval
  12. I have to ask why my 2nd total knee replacement is taking so long it's been 6 months now since I had it replaced. Is it that hard to decide to weather or not grant me the 100% temp for the 1 year? or is the VA trying to figure out how to add a secondary to my first Total knee replacement? which I was awarded 30%. My first Knee replacement only took 6 weeks to process and get paid, but 6 months is a bit to far out there waiting when this claim should have been as easy as the first claim was. here is what my claim says as of today, and another thing I never heard of a secondary for a total knee replacement unless it has to do with the VA replacing the whole knee joint for a second time around on the same knee Status of Your Claim PREPARATION FOR DECISION Submitted: 08/01/2018 (Compensation) Estimated Completion: 11/09/2018 - 12/04/2018 Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New) Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS Current Status: Preparation for Decision
  13. Thanks. I never had this problem with my first Knee replacement it only took 6 weeks to get the 100% temp and be awarded 30% disability, but now I had to have the knee replaced again with all new hardware on the same knee I did not think I would end up with this much trouble for another 100% temp again seems like this time it is being stonewalled until someone feels like getting around to it, and if they do then the Retro back pay from June 4th 2018 you would think they would try to avoid that mess.
  14. Any reason my claim just jumped to unable to provide a completion date for my Total Knee Replacement I had back in June 4th 2018? Submitted: 08/01/2018 (Compensation) Estimated Completion: At this time, your Regional Office is unable to provide an estimated completion date for this type of claim. Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New) Representative for VA Claims: OREGON DEPARTMENT OF VETERANS AFFAIRS Current Status: Preparation for Decision
  15. Everything was filed as before so nothing different has changed on my second knee replacement claim. the VSO has not been a big help this time because she calls the very same 1-800 number like all of us vets do. So I have been told I will get the 100% temp but for the VA to keep extending my claim out is just wrong for some unknown reason. I hate calling the 1-800 number because you don't get any information and they are reading what comes up on your e benefits anyway. The VA paid for the surgery all $28,756.20 dollars worth plus an additional $7,689.40 for the help and hospital care and not counting 18 weeks of therapy for the knee have not seen that bill yet. Tri West under contract by the VA under the Choice Care program paid the bill
  16. I have no ideal why I'm having so much trouble with my second total knee replacement service connected on the same knee? They did a revision which what they did was replaced the whole knee again on the same knee so I filed a claim on 4/15/2018 and the claim was lost for some unknown reason, then I filed a second claim on 8/01/2018 Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New) Estimated Completion: 12/03/2018 - 02/17/2019, the new Estimated Completion: 02/17/19 -06/15/19 they seem to be extending my claim out for some unknown reason unless they are waiting on the new budget but I doubt that. The VSO was no big help either, I did call the 1-800 number and asked if I would be getting retro back pay for the 100% temp and the young lady said that the VA has changed some of their requirements and guidelines on retro back pay but could not tell me anything more, My first knee replacement I received my 100% temp with in 6 weeks after the surgery and I was awarded 30% but Jesus Joseph Mary why so long this time?
  17. I have to say the VA is one messed up system I say that because I'm having more issues with my 2nd total knee replacement on the same knee service connected than I did with my first. I had the knee replacement on June 4th 2018 and now my claim has been moved to 02/25/2019 to 12/01/2019 that would mean a large sum of retro back pay for the 100% temp. the claim is still under review of evidence what more can you send, and the providers did their part sending in the very same information I sent in so now my claim on e benefits: Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New). 

  18. So this is what is stated in my claim on e benefits: Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New)
  19. Also my 2nd Total Knee replacement went from Knee Replacement to Knee Replacement (Secondary) the VA claim center changed it to a Secondary condition even through it was a Total Knee Replacement 2nd time around on the same knee, so I have a feeling this (Secondary) word that was added into my claim has me thinking that it will not make the temp 100% but add an increase to the 30% I'm already receiving for the first knee replacement on the same knee I could be wrong but I have never heard of a claim for a total knee replacement 2nd time around as a "secondary condition" I could not find any reference for a claim for Secondary but the claim is being processed as like I'm going through the 100% temp claim, confusing I know. anyone have an ideal why the VA added the word Secondary? So this is what my claim says : Disabilities Claimed: total knee arthroplasty (Secondary), knee replacement (Secondary), Temporary Total Disability (New)
  20. That makes sense but I have seen the VA I worked for do some really stupid crap the way they pay their bill's like milking one veteran to help pay for the other veteran while reducing cost for care so monies can be utilized elsewhere in the best interest of the VA, but that's from my experience and my opinion.
  21. No I did most of my filing on my own with success because some of the organizations that help me from the start were not in the best interest but for them self's, I only looked for a VSO this time because my claims were missing and then they took the 20% reduction rating away for scars and gave me a 0% which I found out I have to file a new claim just for the scars, after the knee replacement which is kind of dumb because My scars have not disappeared and the VA knows I have them otherwise I would not have been getting a 20% rating for service connected. I finally retained an attorney for my Malaria claim since I was denied twice he says I have a case because my records shows I contracted it in 1995 and the VA recognized it while on active duty, but the VA makes it look like I contracted Malaria in Portland, Oregon anyway that's another story.
  22. So just to understand this, are you saying that it is ok for the VA to charge my private insurance for my combat related injury's and it's ok for me to pay my own deductible in order for the VA to help pay health insurance for a fellow veterans care that has no insurance? Sounds like socialized healthcare. from what I understand and working for the VA all combat related service connected injury's are paid by the government NOT your private health insurance or am I missing something here?
  23. You should have seen what the VA facility did when I worked for then before I retired, from the VA would charge the Veteran for his service connected injury's during his visits through his own health insurance plan, like Blue Cross for example which has nothing to do with his injury's so then the VA would charge his insurance company and in order to help pay for veterans that did not have health insurance and the billing office says this was legal and the veteran should not complain because he is helping the veteran out by not having health insurance. because this happened to me so I made sure Blue Cross denied any claim the VA was sending to them for payment for my service connected injury's. Talk about scam and the funny thing is that most if not all private health insurance company's don't know what the VA is doing and they just pay the bill. prime example it took me 3 months to get the VA to return $8,000 back to Blue Cross and Blue Shield, Now when the VA asked me if I have private health insurance I have blue cross block the VA from using them for payment. I think the VA has taken a major wrong turn in the wrong direction.
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