Jump to content
VA Disability Community via Hadit.com

VA Disability Claims Articles

Ask Your VA Claims Question | Current Forum Posts Search | Rules | View All Forums
VA Disability Articles | Chats and Other Events | Donate | Blogs | New Users

Vync

Content Curator/HadIt.com Elder
  • Posts

    6,169
  • Joined

  • Last visited

  • Days Won

    159

Everything posted by Vync

  1. I hope you have a positive outcome and good luck on the rest of the exams
  2. @pro-se It might be worth it to contact the author of that article and ask them to show you where it says they don't have to worry about a reduction. Ask specifically where it is in the law, regs, or VA policies involving the PACT act. Of course, that's still one of those things the lawmakers should in future laws. It would remove the anxiety of vets and allow them to be comfortable when filing new or increased claims.
  3. @Dustoff1970 Same thing happened to me when I filed my initial claims after service. The claim form and a full copy of my service treatment records were sent in the same envelope. Not long after, I got a denial letter saying my STRs were silent for all claimed conditions. My VSO actually decided to lift a finger on this one and found they made the decision based on the contents of my claims folder which was practically empty. The misplaced STRs were never located, so they were resent... @broncovet Agree regarding symptoms. Don't forget how they also rely on continuity of symptomology against the vet. The vet can say the issue bugs them daily or weekly, but because they didn't go to the doc there is nothing documented, thus it gets denied.
  4. @jfrei I think you should look at 38 CFR 4.40 and 4.45, plus this link to M21-1: https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000014407/M21-1-Part-V-Subpart-iii-Chapter-1-Section-A-Painful-Motion-and-Functional-Loss In the M21-1 article, the word "flare" shows up 16 times. What you described seemed a bit sketchy. Get a copy of the C&P exam to see what was noted. It sounds like they might have been rating you based on what they could confirm at the time of the exam, but since they could not assess you in the middle of a flare up, unless they had medical records proving it the examiner likely disregarded what you told them. I have had shoulder surgery which left me with frozen shoulder and ROM less than 5% on each axis. It was not fun, so I can definitely sympathize with you. Of note is this, but several other decisions have modified this further so don't forget to read the whole article Aside from that, when filing for an increase they can factor in medical evidence from the preceding 12 months to grant an earlier effective date.
  5. @jennifer1981 Years ago, copies of the C&P results used to be placed directly into the VA medical records. We could go to the VAMC release of information office or use the MyHealth Vet site to download them. A couple of years ago the VA changed that and relied more heavily on contractors. They send their findings directly to the VARO instead. I asked LHI to send me a copy, but they claimed they were not allowed. Unless you have a VSO with access to the VA records system, the only other way to get them is requesting them which can take a very long time. Since most claims are closed before you get your C&P findings, vets are still in the dark about what exactly was said, except for the sections the VARO quotes when authoring decision letters. It really stinks.
  6. I would imagine it would be similar to the video conference you had previously. You can actually look at the DBQ's online at your convenience right from the VA's web site: https://www.benefits.va.gov/compensation/dbq_publicdbqs.asp. This will give you a reasonable idea of what the examiner might ask. If you have the ability to print it, you could fill it out from your perspective to the best of your knowledge. Just go down to "Psychological" to find three DBQs and just read the ones which apply. Keep in mind that they change the DBQs up periodically. I really wish the VA would include the DBQ web site address when sending out C&P exam letters so vets would have an idea of what to expect. Keep in mind the examiner may have already reviewed your MH treatment record history. They might only ask a limited set of potential questions. This is the link to the rating criteria § 4.130 Schedule of ratings—Mental disorders: https://www.ecfr.gov/current/title-38/chapter-I/part-4/subpart-B/subject-group-ECFRfa64377db09ae97/section-4.130 I included it so you can look at the way they are rated. Each row in the table can have one or more set of criteria.
  7. @PatricBrien Welcome to Hadit! It is still sketchy and subject to being screwed up. I have called late in the day and requested an appointment for first thing the next day. They tell me what time to come in. I show up and submitted travel. When the check arrived it was only for one day. I inquired and learned that the clerk noted me being a walk-in. They would not pay for both ways because of how the clerk entered the visit into their system. By the time I had received the payment, a month had passed and the clerks at the clinic did not remember me calling due to the number of vets that visit each day. The whole appointment or not doesn't make any sense either. The vet either traveled to the provider or not.
  8. @Dustoff1970 Personally, I really liked going to my VAMC and standing in line at the cashier to cash out my travel voucher. I was able to immediately grab some lunch or put the rest into my gas tank. Then someone got a bright idea about centralizing everything and using direct deposit. At least they still printed out the form, asked you to sign it, and then drop it into the voucher collection box. Now they screwed it up even more. Reminds me of the old saying, "If it is not broken, then don't fix it." They had some good potential options which were really pro-veteran and decided to raise the inconvenience level.
  9. @brokensoldier244th That seems promisingly odd to roll this back out slowly. This will benefit all veterans with POAs who perform the screenings. However, the removal of it should have never occurred in the first place. @Dustoff1970 That's pretty awful. My father retired in 1990 and the VA exam gave him SC ratings of 0% and 10% which were likely lowball assessments. Your description of the boozy doc reminds me of being a dependent and going to some of the Army base docs back in the 70s. @Riplip I hope you get a competent follow up on this. Filing a BBB complaint is actually a good idea.
  10. @El Train Those timeframes don't make a whole lot of sense, but instead fuel the ability of people to scare vets by advising vets no to "rock the boat". I'm 100% P&T, under 55, and have not yet crossed the 20 year finish line. I filed a CUE for 20+ year old errors which eventually was appealed to the BVA. My VSO rep actually told me not to file any more claims of any type because I did not have 20 year protection yet. These timeframes need to be reduced significantly based on reality. 5 years should be reduced to 1 year because if the VA can't miracle cure you in a year, it's likely going to continue for years anyway. Even if the vet has their cancer cured, they still end up dealing with the residuals of the treatment anyway. 10 years should not be a factor at all because how may times have you heard SC being severed outside of fraud being proved? 20 years is a lifetime away and some vets never live long enough to reach it. Any P&T, IU/TDIU, or 55+ year-old vet should automatically be protected from any kind of reduction or SC severance just on principles of the facts alone outside of fraud being proved. Of course, these are just my opinions.
  11. I also encountered the same problem as @Riplip numerous times with C&P examiners. In each case, competent medical evidence was provided and/or available to them and we discussed it thoroughly. They said it was clearly favorable. My VSO was able to provide me with a copy of the C&P findings each time days before the decision letter was entered into the system. The opinion was less likely than not. The examiner completely failed to mention or consider the favorable evidence. I called the call center, sent an IRIS message, and even the VSO contacted the VA. However, a couple of weeks later a denial letter arrived which also failed to consider favorable evidence. I ended up winning via HLR about a year later. When the VA took away the 48 hour VSO decision review, this amplified the problem. Even though my VSO did not always catch the errors I found during the review, sometimes they did. With the VA actively preventing vets from obtaining the C&P findings, we vets don't know there is an issue until we receive the denial letter. By then, the claim has been closed and we are stuck with supplemental, HLR, or BVA routes which simply makes those queue lines longer...
  12. Since the VAMC clinic clerks no longer print travel vouchers, we are now forced to either fill out and mail the form or use the online travel system. Half the time the online system does not work properly. It would be great if the VA could automate this for vets to a varying degree. If going to a community care appointment, a claim would still be required because the VA system does not integrate with their systems. The VA really should automatically issue travel claims for those which can be detected in their system. For example, if you are SC for something and see a VA provider, issue the claim payment automatically. The same for 50%+ vets or those attending an on-premises C&P. Whether on paper or online, the claim system makes a vet affirm that they are not submitting a fraudulent claim every time. However, they don't do this to issue monthly compensation payments. What does everyone else think?
  13. @Sgt. Wilky I am so sorry for the loss of your son last year. Please accept my condolences on losing him. I am glad the judge increased you to 70%.
  14. I spoke with CHAMPVA and they referred me to the OptumRX hotiline 888-546-5502. It's an odd situation which is based on your circumstances. In my case, my wife and I both work and have separate health insurance through our employers. They said employer medical insurance must go through first payer, second payer, etc... and then we can file a claim for any out of pocket. The items are limited to what is on the CHAMPVA formulary list which explains what they will cover and adhere to their rules and guidelines. I was told when you get CHAMPVA it goes back to the effective date, but you only have a year to apply. Otherwise, the one year to reimburse applies going forward. Everything has to have a doctor's prescription, nothing over the counter can be reimbursed. Just file a claim with CHAMPVA like you would for any prescription reimbursement. I just go to the pharmacy and ask for a printout of what insurance paid and what was leftover as my responsibility. I do this anyway for my wife and kids because their system does not allow a third insurance system to be entered. I make a copy and mail it to CHAMPVA. Currently, they are about two months behind opening their mail. They estimated it could take up to an additional two months to process and issue any reimbursement payment which might be due. Please realize that I do not have Tricare, so that does not apply to my situation. I don't know how it might work for medicare or other situations. They did tell me that if employer covers prescriptions, I can't use their MedsByMail service. However, they said that in some situations they might make an exception. Of course that program appears to provide only generic meds, nothing brand named. Best bet is to call the CHAMPVA or OptumRX hotline because the system is so convoluted. I don't know if the info I was told was accurate because some of it seemed to conflict with the web site, but I have seen a lot of that with the VA in the past.
  15. Thank you for the information! Medicare is not involved here, but that info is very good to know. I have been quite busy with work, so I have not had the opportunity to call CHAMPVA yet. Definitely will share what they tell me so others might benefit.
  16. My GERD C&P consisted of two parts. The first was the traditional exam, but they brought me back to have an upper GI. However, I think that still counts as a single exam.
  17. Could this be some form of due process and/or duty to assist violations resulting in the veteran being harmed by the VA failing to maximize benefits? For example, my first C&P's were the result of a BVA remand with very specific instructions. It seems the BVA was attempting to maximize my benefits and fulfil their duty to assist, but the VARO and the C&P examiner dropped the ball. The BVA remand required a review my claimed issues, but also any other issues which are present. It also required the examiner to opine as to SC for all found disabilities, not just the claimed disabilities. I did initially claim TMJ and was prescribed multiple times daily NSAIDs. During the exam I also complained about heartburn. The examiner diagnosed me with reflux, a very common side effect of NSAID use, but failed to opine regarding SC. The examiner and the VA did not notify me that they diagnosed any unclaimed disabilities. It was not on the rating decision letter and they did not send me a copy of the C&P exam findings. After finding Hadit years later, I requested a copy of my entire claims file and learned of the diagnosis. I filed for reflux and won SC as secondary to TMJ. I was still learning at the time and did not know it was possible to file for an increase and request an EED. I asked about this here previously and was told the lack of an opinion on those other issues was considered a "deemed denial". In other words, if they did not say "yes", it meant "no". The 1 year appeal window has come and gone. However, I still wonder if this could still be considered an open claim because the VA failed to follow the initial BVA remand instructions... Probably not because I won SC later...
  18. @broncovet Sounds like a familiar tale amongst many of us. My ex-wife was large, lost a lot of weight, had plastic surgery, and began working most nights and weekends. I took our daughter to softball practice for years and some of the parents had no idea I was even married. She missed some of the best years of our daughter's life. Eventually she filed for divorce and tried to stick me with paying for loans she took out to pay for her plastic surgery. The judge laughed and said nope! Later, she got fired from her job for sexually harassing other employees. Years later I remarried and have two wonderful young boys. My wife was a bit heavy and had surgery, but does experience the struggle with looking in the mirror and not noticing she lost half the weight she had. However, she has a good heart and I am helping her through the struggles. In my opinion, mental health counseling associated with weight loss should be required whether weight loss is obtained through surgery or not. @dlooshnl The VA MOVE program has been helpful for me. I was almost 250 at one point and had a heart attack later after losing some weight. I am around 200 now and signed up for the MOVE program to help me figure out how to change my lifestyle and hopefully drop to around 160. To look at me people would not think I am overweight at all, but a lot of it is still muscle. However, the musculoskeletal and heart disabilities make it a challenge. Don't give up.
  19. Good information from @pacmanx1. I'll add that sometimes a doc or examiner might indicate that your disability is not expected to improve. That could help you possibly avoid being brought in for a re-examination or possibly even having the disability considered static. However, keep in mind that mental health disabilities rarely get classified as static initially unless you have a long history which actually shows you are not likely to improve. If you are unable to work due to your SC disabilities, consider asking for IU or TDIU status. It will bump up your compensation to be paid as 100%. Another thing to consider is side effects of medications used to treat your SC disabilities. A good example is musculoskeletal disabilities. The Army believed motrin could treat all ailments and dished it out to us often. Motrin is an NSAID which is a class of meds that can wreak havoc on your digestive system in the long-term. It can also be related to serious heart issues. So if you are not SC for heartburn, but took NSAIDs for long time to treat your SC musculoskeletal issues, consider filing for it, etc...
  20. @Remisdad Sometimes arrogance is a factor of quality as long as they can reasonably deliver quality work. I had some VSOs like yours in the past. My first one filed a bunch of claims using a single sentence, but it took me five years of appeals with the BVA to get some of the issues SC. The only time I ever had a VSO use profanity was when I had a local DAV lady read the denial letter I received. She said it was BS. That was not long after I joined hadit and began to learn to handle my own claims, too. I would just draft up the claim and let her review it. She eventually retired and the replacement was more green than broccoli. When I had a home phone, I would fax my own claims to the VA. Now I submit them online and simultaneously send them by mail return receipt. I do all of my family's CHAMPVA submissions on my own.
  21. One of my dependents is diabetic. Does anyone know if CHAMPVA will cover and/or reimburse for out of pocket diabetic supplies? For example, glucometer, test strips, lances, alcohol pads, etc... I tried looking on the CHAMPVA site and must have missed it. I'll call them at some point later in the week, too... Thanks!
  22. @broncovet That is definitely true. If the VA had not rushed in many of my claims, they would have been half as thorough as I was and found the obvious evidence to grant SC. @Remisdad My current VSO rep advised me to stop filing claims. About 10 years ago, a different VSO rep from the same organization told me if all vets were as thorough as I was, he would be out of a job....
  23. @broncovet Was that the Hodge v. West decision from 1998? I wish it applied to non-TDIU claims where new disabilities were diagnosed during the C&P exam, but never adjudicated by the VA. Of course, the VA never proactively notifies the vet of the newly diagnosed disabilities. The only way the vet would learn of them would be to formally request the C&P results or their claims file. By then, years may have passed so the vet is out of luck to get retro back to the date of diagnosis.
  24. @Remisdad Would you be willing to answer a few questions involving your BVA appeal? This information would be helpful to myself and others who are stuck in limbo waiting on the BVA to make a decision. 1. When was your appeal submitted to the BVA? 2. Was it a legacy appeal or an AMA appeal? 3. If you opted for a hearing, how long did it take to get it? By the way, congratulations on your win!
×
×
  • Create New...

Important Information

Guidelines and Terms of Use