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Rhodesia
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Posts posted by Rhodesia
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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.
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6 hours ago, pwrslm said:
You will eventually figure out that a few idiots in the office are responsible for 95% of the problem, the rest are fairly competent and mostly professional.
Thank you for the reply back to my posting.
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27 minutes ago, pwrslm said:
" 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"
Problem with this is that they are obligated to put that in writing and give a reason and basis for everything that they say related to the denial of benefits. If they VSO had an issue, I would bee-line this straight to the WH hotline first off. Take 2 weeks, and if they dont reply, call the WH hotline again. They must tell you the exact CFR, USC, and VA Policy reg that they followed, no exceptions.
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.
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8 hours ago, Vync said:
I would ask the 1-800 folks which regulation states that you could only get it once per SC disability.
You should receive your decision letter/SSOC any time now. That should provide additional information which you can look up to verify.
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.
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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
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On 10/23/2018 at 3:07 AM, broncovet said:
I count about 3 months from August 1, when you apparently submitted the application, not 6 months. It also says preperation for decision. However, ebenefits is unreliable, and most of us know that.
Still, if August 1 was your correct submission date, 3 months is lightning fast for VA. I have never had a claim completed in less than 6 months, with the exception of the initial denial which was completed in barely less than 6 months.
My advice is to be patient and ignore the "estimated completion date".
I opted into Ramp on August 8, about a week after you filed, and my ebenefits shows the RAMP has made "0" progress since August, if its any consolation. Mine is still in "claim recieved". Of course, with ebenefits, you have no idea what is the truth..its sort of like the rest of the VA, you can not trust VA employees to tell you the truth.
Some years ago, I heard that somone called the IRS for advice..that agent told them to do "x". They did. Later, it was discovered that "x" was very bad advice and wrong. So the person sued the IRS for giving bad advice which cost him money. The IRS won.
In a nutshell, the courts have ruled if an agency gives you faulty advice, the agency is not "held" to that advice, and is not responsible for it.
They dont have accountability, and the VA employees take full advantage of this..telling you anything to get you off the phone. Once you understand this, for me, it was empowering. Its one thing to be lied to, but still another when you recognize that as a lie. Generally, when I speak to somone, I always give them the benefit of the doubt, assuming everything they say is the truth, UNTIL I find out different. However, once I catch them in a single lie, I discount the rest of what they say as also a lie. Well, the VA has got my mistrust the old fashioned way..they EARNED IT.
This is sad, and especially so, for PTSD Vets. You see, you kinda need to trust your VA therapist and beleive he or she is on your side. Or, you dont tell them NOTHING. This is a cause of the high rate of Veterans suicide. The PTSD Vets dont trust the therapist, so they dont tell them what is really wrong, or even if they are "at risk of suicide".
I have been treated at the VA since the late 1990's. There are a couple people at the VA who have earned my trust, and I open up to them. They have earned it over decades. Most, however, have not earned my trust, so I tell them pretty much "Nothing".
My attitude on this is not unique. My son does not trust anyone at VA. And he wont even go there, except for emergency treatment, and then he never goes back, even for followup. He desperately needs PTSD treatment (he was in IRaq) and wont get it because he does not trust VA, in no small part because he knows they lied to me.
VA needs to fix this "trust problem" in order to fix the suicide problem. VA employees who tell Vets "wrong stuff" need to be held accountable.
My parents taught me honesty by modeling that behaviour. The VA teaches Vets dishonesty by modeling that behaviour. Then they wonder why many Vets, who need treatment, wont get it.
I have learned I can not do business with someone who I dont trust. When you go to McDonalds, you buy a sandwich because you trust that those employees did not put posion or something bad in your sandwich, or french fries. If you lose that trust, then you probably wont eat there. Each time I have gotten sub standard food at McDonalds, and brought it to the managers attention, he immediately replaced the defective food. He dealt with my issues immediately. So, I trust them, (not that I eat at McDonalds all the time). McDonalds has earned millions of people's trust. One way (that I like), is that you can go to a McDonalds, use the bathroom, and not buy anything. Sometimes, that is what I need. I need a bathroom, and I can count on McDonalds to have a fairly decent restroom, and not whine that I did not buy something. Since I do feel comfortable and trusting, sometimes I do buy something, even when I just went there to use the bathroom.
Ditto for Amazon..they have great service and have earned my trust, doing refunds when I was not satisfied. Why cant VA do something as simple as earn our trust, by simply doing what they are supposed to do? Its not rocket science. Just hold employees accountable. If you talk to a Va employee and his statements are suspicious, then you should be able to bring that issue to his or her supervisor and have it fixed. Of course, it could well be that it was YOU who did not understand, and hopefully the supervisor can explain it.
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
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On 10/23/2018 at 3:07 AM, broncovet said:
I count about 3 months from August 1, when you apparently submitted the application, not 6 months. It also says preperation for decision. However, ebenefits is unreliable, and most of us know that.
Still, if August 1 was your correct submission date, 3 months is lightning fast for VA. I have never had a claim completed in less than 6 months, with the exception of the initial denial which was completed in barely less than 6 months.
My advice is to be patient and ignore the "estimated completion date".
I opted into Ramp on August 8, about a week after you filed, and my ebenefits shows the RAMP has made "0" progress since August, if its any consolation. Mine is still in "claim recieved". Of course, with ebenefits, you have no idea what is the truth..its sort of like the rest of the VA, you can not trust VA employees to tell you the truth.
Some years ago, I heard that somone called the IRS for advice..that agent told them to do "x". They did. Later, it was discovered that "x" was very bad advice and wrong. So the person sued the IRS for giving bad advice which cost him money. The IRS won.
In a nutshell, the courts have ruled if an agency gives you faulty advice, the agency is not "held" to that advice, and is not responsible for it.
They dont have accountability, and the VA employees take full advantage of this..telling you anything to get you off the phone. Once you understand this, for me, it was empowering. Its one thing to be lied to, but still another when you recognize that as a lie. Generally, when I speak to somone, I always give them the benefit of the doubt, assuming everything they say is the truth, UNTIL I find out different. However, once I catch them in a single lie, I discount the rest of what they say as also a lie. Well, the VA has got my mistrust the old fashioned way..they EARNED IT.
This is sad, and especially so, for PTSD Vets. You see, you kinda need to trust your VA therapist and beleive he or she is on your side. Or, you dont tell them NOTHING. This is a cause of the high rate of Veterans suicide. The PTSD Vets dont trust the therapist, so they dont tell them what is really wrong, or even if they are "at risk of suicide".
I have been treated at the VA since the late 1990's. There are a couple people at the VA who have earned my trust, and I open up to them. They have earned it over decades. Most, however, have not earned my trust, so I tell them pretty much "Nothing".
My attitude on this is not unique. My son does not trust anyone at VA. And he wont even go there, except for emergency treatment, and then he never goes back, even for followup. He desperately needs PTSD treatment (he was in IRaq) and wont get it because he does not trust VA, in no small part because he knows they lied to me.
VA needs to fix this "trust problem" in order to fix the suicide problem. VA employees who tell Vets "wrong stuff" need to be held accountable.
My parents taught me honesty by modeling that behaviour. The VA teaches Vets dishonesty by modeling that behaviour. Then they wonder why many Vets, who need treatment, wont get it.
I have learned I can not do business with someone who I dont trust. When you go to McDonalds, you buy a sandwich because you trust that those employees did not put posion or something bad in your sandwich, or french fries. If you lose that trust, then you probably wont eat there. Each time I have gotten sub standard food at McDonalds, and brought it to the managers attention, he immediately replaced the defective food. He dealt with my issues immediately. So, I trust them, (not that I eat at McDonalds all the time). McDonalds has earned millions of people's trust. One way (that I like), is that you can go to a McDonalds, use the bathroom, and not buy anything. Sometimes, that is what I need. I need a bathroom, and I can count on McDonalds to have a fairly decent restroom, and not whine that I did not buy something. Since I do feel comfortable and trusting, sometimes I do buy something, even when I just went there to use the bathroom.
Ditto for Amazon..they have great service and have earned my trust, doing refunds when I was not satisfied. Why cant VA do something as simple as earn our trust, by simply doing what they are supposed to do? Its not rocket science. Just hold employees accountable. If you talk to a Va employee and his statements are suspicious, then you should be able to bring that issue to his or her supervisor and have it fixed. Of course, it could well be that it was YOU who did not understand, and hopefully the supervisor can explain it.
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
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On 10/23/2018 at 3:07 AM, broncovet said:
I count about 3 months from August 1, when you apparently submitted the application, not 6 months. It also says preperation for decision. However, ebenefits is unreliable, and most of us know that.
Still, if August 1 was your correct submission date, 3 months is lightning fast for VA. I have never had a claim completed in less than 6 months, with the exception of the initial denial which was completed in barely less than 6 months.
My advice is to be patient and ignore the "estimated completion date".
I opted into Ramp on August 8, about a week after you filed, and my ebenefits shows the RAMP has made "0" progress since August, if its any consolation. Mine is still in "claim recieved". Of course, with ebenefits, you have no idea what is the truth..its sort of like the rest of the VA, you can not trust VA employees to tell you the truth.
Some years ago, I heard that somone called the IRS for advice..that agent told them to do "x". They did. Later, it was discovered that "x" was very bad advice and wrong. So the person sued the IRS for giving bad advice which cost him money. The IRS won.
In a nutshell, the courts have ruled if an agency gives you faulty advice, the agency is not "held" to that advice, and is not responsible for it.
They dont have accountability, and the VA employees take full advantage of this..telling you anything to get you off the phone. Once you understand this, for me, it was empowering. Its one thing to be lied to, but still another when you recognize that as a lie. Generally, when I speak to somone, I always give them the benefit of the doubt, assuming everything they say is the truth, UNTIL I find out different. However, once I catch them in a single lie, I discount the rest of what they say as also a lie. Well, the VA has got my mistrust the old fashioned way..they EARNED IT.
This is sad, and especially so, for PTSD Vets. You see, you kinda need to trust your VA therapist and beleive he or she is on your side. Or, you dont tell them NOTHING. This is a cause of the high rate of Veterans suicide. The PTSD Vets dont trust the therapist, so they dont tell them what is really wrong, or even if they are "at risk of suicide".
I have been treated at the VA since the late 1990's. There are a couple people at the VA who have earned my trust, and I open up to them. They have earned it over decades. Most, however, have not earned my trust, so I tell them pretty much "Nothing".
My attitude on this is not unique. My son does not trust anyone at VA. And he wont even go there, except for emergency treatment, and then he never goes back, even for followup. He desperately needs PTSD treatment (he was in IRaq) and wont get it because he does not trust VA, in no small part because he knows they lied to me.
VA needs to fix this "trust problem" in order to fix the suicide problem. VA employees who tell Vets "wrong stuff" need to be held accountable.
My parents taught me honesty by modeling that behaviour. The VA teaches Vets dishonesty by modeling that behaviour. Then they wonder why many Vets, who need treatment, wont get it.
I have learned I can not do business with someone who I dont trust. When you go to McDonalds, you buy a sandwich because you trust that those employees did not put posion or something bad in your sandwich, or french fries. If you lose that trust, then you probably wont eat there. Each time I have gotten sub standard food at McDonalds, and brought it to the managers attention, he immediately replaced the defective food. He dealt with my issues immediately. So, I trust them, (not that I eat at McDonalds all the time). McDonalds has earned millions of people's trust. One way (that I like), is that you can go to a McDonalds, use the bathroom, and not buy anything. Sometimes, that is what I need. I need a bathroom, and I can count on McDonalds to have a fairly decent restroom, and not whine that I did not buy something. Since I do feel comfortable and trusting, sometimes I do buy something, even when I just went there to use the bathroom.
Ditto for Amazon..they have great service and have earned my trust, doing refunds when I was not satisfied. Why cant VA do something as simple as earn our trust, by simply doing what they are supposed to do? Its not rocket science. Just hold employees accountable. If you talk to a Va employee and his statements are suspicious, then you should be able to bring that issue to his or her supervisor and have it fixed. Of course, it could well be that it was YOU who did not understand, and hopefully the supervisor can explain it.
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
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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
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4 hours ago, Navy04 said:
Most of the time as we near the end of the year, you will start to see this. Last year I had a claim do the same thing, and within 6 weeks it was completed. Try not to get to worked up. Good luck and God Bless!!
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.
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- 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
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6 hours ago, Berta said:
"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, "
Rhodesia, this sure is news to me- I could not find anything on the net regarding these changes.
If that is true, your VSO should know---but I think the 800# makes stuff up sometimes.
I hope the VSO filled the proper forms for Temp Convalescence.
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
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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?
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57 minutes ago, broncovet said:
I have a secondary rating, and its no different than primary, except the Caluza elements are a little bit relaxed.
Instead of 3 Caluza elements, you need only 2 for secondary:
1. Current diagnosis
2. Nexus, or link between your current diagnosis, and a SC condition.
Notice the "in service event" is not needed with secondary conditions as its presumed by the primary condition.
You dont need to worry whether this is primary, secondary, presumptive, etc. Once service connected, they are all treated the same. In fact, the VA "may" be trying to help you get around (apparently) the fact you already had one temp 100 percent rating for that knee, since you need a second surgury, they are making it sail through by listing it as secondary.
Terms like "primary", "presumptive", "secondary", etc., are mostly for rating specialists to concern themselves with and you need not worry about it. When you apply for benefits, the VA must assume the maximum, and you dont have to say, "I want to apply for presumptive SC for the knee", or whatever. If you have the applicable evidence, they should award it.
In other words, if I applied for a condition as "primary", and it turned out the condition was actually a presumptive, (the Veteran) need not concern himself with this UNLESS, for some reason, the presumptive evidence was not present.
Once you meet the criteria for "presumptive", "primary", or secondary conditions, they are treated the same.
I was just reading a case about that..and I may have even posted something about it.
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)
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On 9/15/2018 at 1:08 PM, broncovet said:
You posted:
The whole idea of having "multiple Insurance policies" is so that the insured's "out of pocket" costs are reduced or, hopefully zero. It does not always work, but this is the idea. Im not advocating you should have to pay a copay or deductable when VA bills your insurance, but I have not seen that happening, tho nothing suprises me with VA anymore.
As far as Im concerned, I dont care who pays for my care..VA or an insurance company, as long as I dont have to pay.
Insurance is designed so that you can not make money with it. In other words, if you have 10 car or health insurance policies, you can not collect times 10..else people would make money getting sick or wrecking their car. Insurance is designed to "protect" you from the risk of loss. Not for you to make money by wrecking your car.
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)
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On 9/15/2018 at 1:08 PM, broncovet said:
You posted:
The whole idea of having "multiple Insurance policies" is so that the insured's "out of pocket" costs are reduced or, hopefully zero. It does not always work, but this is the idea. Im not advocating you should have to pay a copay or deductable when VA bills your insurance, but I have not seen that happening, tho nothing suprises me with VA anymore.
As far as Im concerned, I dont care who pays for my care..VA or an insurance company, as long as I dont have to pay.
Insurance is designed so that you can not make money with it. In other words, if you have 10 car or health insurance policies, you can not collect times 10..else people would make money getting sick or wrecking their car. Insurance is designed to "protect" you from the risk of loss. Not for you to make money by wrecking your car.
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.
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2 hours ago, vetquest said:
Why did you need to refile. Any VSO worth their salt keeps copies of everything submitted scanned into their computer server. If this VSO did not you need a new VSO. I will bet the VA is trying not to pay the 100% temp. Once my records disappeared from the San Diego VA. They wrote to my senator that I had never been treated at their hospital. they agreed to add any copies of their records that I had. I had copies of some of them. I then tried to get an appointment and they said I could not because their records said I had missed three appointments.
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.
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1 hour ago, broncovet said:
Rhodesia
I dont have a problem with VA billing insurance companies. VA has limited resources, obviously, so if a Veteran DOES have alternative insurance, then I see no problem shifting the burden from the VA to a private insurance company.
Many Vets have private insurance in addition to VA. Personally I have a medicare Advantage plan, and it makes "0" difference to me what/if (Humana) pays any portion, as long as I dont have to pay anything. I have this because it gives me more choices. I dont always want to be forced to HAVE to use VA, sometimes, or even lots of the times, private care is better. Some Vets wont set foot in a VA facility, and many have real valid reasons for not doing so.
Since its (apparently) legal for Va to bill our insurance companies, I say, if this makes VA's finite resources go further to help more Vets, then, I think they should do this. Of course, I dont think this gives VA a carte blanche check to steal from VA and Vets, but there is legislation proposed which would have stricter penalties on government corruption. Of course, much of the government corruption can come from some very high levels of government, where prosecution is very tough.
Rooting out government corruption is more than just "fair", its essential to our continued prospertiy. We have way, way too much government corruption, and VA is probably the worst of the worst, apart from politicians themselves. I think government corruption is behind 85 percent of first time claimants gettting denied. The VA simply does not have resources necessary for both government corruption and to take care of Veterans, so guess which they give priority to?
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?
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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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Ok I have a problem again, I filed a claim for a service connected injury for a Total knee replacement on 4/15/2018 all necessary paperwork including VA forms were submitted, that claim somewhat disappeared 4 months later, so I submitted a second total knee replacement claim on 08/01/2018 they have labeled it as a secondary condition claim because I had to have it done all over again to replace the total knee again I had in the first place so in another words I had two total knee replacements on the same knee., I submitted all necessary VA forms and documentations as before, this morning on 09/14/2018 I was notified that I need to submit evidence all over again and I have until 10/10/2018 and the claim was move back to 05/15/2020 (What the Hell) what I uploaded all disappeared again, plus they are asking for Tri West billing statements this time because it was paid through the choice care program and approved by the VA. that's a first. They did not ask for that the last time so I resubmitted all documentation all over again and the new VSO I went with she is about as useless as pigs with wings. So am I missing something here or is the VA trying to NOT pay the 100% temp for the second knee replacement and making it a secondary condition. I have not found anything that makes a second total knee replacement a secondary condition unless someone out that has gone through this before?
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On 9/6/2018 at 4:12 AM, broncovet said:
Well, dont count on your VSO, especially if she (was) going to permit an unauthorized reduction contrary to 3.344. There are regulations that protect Vets, and this is a huge one.
The VA has to show they met 3.344 as well as duty to assist. They are required to give you 60 days written notice of a reduction AND an opportunity for a hearing so you get to say your side, and protest the reduction.
Its a violation of your due process 38 cfr 3.103, when VA reduces your rating absent the proposed rating reduction. This decision maker is hoping you are uninformed of 3.103 and 3.344, so you will let it go, and it will become final in a year.
This is another VA trick. They make you think they know the regulations..and that YOU dont. I beg their pardon, sir. I learned to read by the time I was in 2d grade, and could read a newspaper cover to cover. And, I learned how to use the internet in 1995, and how to do google searches in year 1999. Dont let them bluff you.
Ok I saw the VSO and read the reason why the VA reduced my rating for my scars from 20% to 0% Since I had surgical scars on my knee prior to the total knee replacement the VA grouped them into the total knee replacement since the knee replacement would create scars from the surgery, the only way I can get an increase for the scars if 1. they are causing severe pain, 2. bleeding from the inside, 3. scars are not showing any signs of healing, 4. submit for an increase for the knee and hope to get 60% other than that i'm F#@ked. the VSO said she is seeing allot of the VA consolidating service connected injures into a category. I mentioned the regs you gave me and her first impression was what attorney gave me that and who did I talked to. I told her I got that information from the VA regs book since I worked for the VA. well anyway now I'am waiting for my second knee replacement claim to close out it is in the review evidence phase she did say I will get the 100% temp for the 1 year after a few calls to make sure because she said that sometimes after a second total knee replacement on the same knee the VA will require you to comp and pen before they award you the 100% temp, confusing, Trump is suppose to make this process more easier but it seems to be allot hard now. She said that she noticed that most of my conditions I claimed under the Gulf War Illness she said that most of the Gulf War veterans are staying away from that claim because they are tagged like vietnam veterans are for applying for Agent orange, I guess I should not have registered for the Gulf War, Burn Pits, and the Camp Lejeune Hazardous water illness registry for the VA. Not my fault the VA sent me these letters and found that I was in these areas and now I have 3 letters with Bar Coded numbers assigned to me from the DOD records, So I assume 40 years from now I will feel the effects of these conditions, unless I'm dead by then, LOL
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5 hours ago, Richard1954 said:
I don't remember so I'll ask were you in the reserves, I ask because no one I know unless they were not in the active service had to wait to get their retirement. I received my retirement check the first month after retirement. For many years, 22 to be exact I took my VA compensation over my retirement because it just made things easier. Now I receive both combat related compensation and my va check and pay no taxes on either.... but for years like many retirees I did not get a retirement check instead taking va comp.
8 active and 14 in the reserves 22 years total (Not counting the 5 years I spent in the (French Foreign Legion) I was informed by the retirement office I will get some type of retirement what they do is offset what you get from the VA disability if your rating is under 50% then when you get a 50% rating or higher then you get your full retirement, the 40% is what is going to kill me did not know they changed the law in 2008 where you had to have 50% or more in order for you to keep your full retirement.
My cousin was in the Marines did his 20 years received his retirement from the Marines and when he filed his VA disability they just about raped his marine corps. retirement pay to almost nothing, they sent him a letter that he can only receive one disability either choose the VA or Marine corps. so he took the VA until he got his rating up to 80% and then DFAS re adjusted his marine corps retirement back to full payment talk about a screwed up system for veterans.
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2 hours ago, broncovet said:
File a nod, disputing the reduction decision, citing 38 CFR 3.344. Read over the regulation carefully. Do so within a year of the reduction decision. Send them the picture you posted..its pretty convincing.
Yea I have an appointment on the 10th with the VSO she agrees with you for the NOD she said the letter is kind of misleading funny I have never received anything yet.
38 CFR 4.30 Denied for total knee replacement service connected
in VA Disability Claims Research
Posted
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.