Vync

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...

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?

@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%.

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.

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.

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.

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...

@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.

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...

@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.

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!

@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....

@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.

@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!

Sorry for the delay in responding, but no change - still waiting to be assigned. My VSO initially said it would take about six months after the hearing, but that was about 8 months ago. I did get a letter in the mail last month which pretty much said they are swamped and would get to me eventually. @broncovet Both times I have been before the BVA, I was given no information as to the identity of which BVA employee might attend. I simply found out when I attended each meeting. Back in the late 1990s, it was the same thing. I met the BVA dude when I walked in the office. That was a much better situation because it was interactive. He asked specific questions and I answered him. I also had a chance to ask him questions and received fruitful feedback on the spot. He was not impressed when he learned the denial was because the VARO made their decision based on an empty c-file. The video hearing last year was just one sided after they asked me to briefly explain why I disagreed with the denial. I was not allowed to ask any questions or get any realtime feedback because the decision would be made by someone else eventually. It seems like the BVA structured their process like this to simply be able to report to management and lawmakers that they completed X number of hearings very quickly. However, what matters more is getting a correct assessment of the evidence and a decision.

You can now download your VA decision letters from va.gov, but there's more to know before getting too excited about it: I followed the instructions in the video and was able to download my decision letters, even some which went back to the mid-1990s. Here are some important things to consider (based on my personal observations and opinions): I recommend disregarding the narrator's advice to no longer need to keep a paper copy of the records. You should always keeping a copy of anything related to a VA claim. The VA did not make it easy to download the decision letters. You must go into any close claim and click a link to take you to the download page. A list of up to 10 decision letters per page will be displayed. Yes, you must click each link individually to download just one decision letter. The VA could have placed the download link in a more convenient location and also provided an option to download all decision letters at once either as a single PDF file or a zip file containing multiple PDF files. The download links contain more than just letters related to claims. I found non-claim related documents such as annual increase letters, direct deposit changes, retroactive payment details, dependency awards, "we are currently working on your claim blah, blah, blah...", Some decision letters are duplicate copies or other decision letters . Some decision letters did not include your appellate rights documents. Some included the name of the form under "enclosures". Some actually did include the appellate rights documents. The decision letters are incomplete. Most of mine only contained the quick overview page. Most did not include the actual rating decision, evidence, and reasons for decision pages. I can imagine calling Peggy 1-800-827-1000 and trying to talk with the agent for them only to find that most of what you need to know is not in the download. Given the circumstances, if you want a copy of the decision letter which is due to arrive in the mail very soon, get a POA with a VA-certified VSO and ask them to download and print the decision letter. Keep in mind that not all VSO's will do that... I guess this is a step in the right direction, but the VA still has a lot of improvements to make. I guess something is better than nothing.

@asdf Looks like he said "I am 100% disabled SC would it have any benefit to file and update my rating of 0", however it is not clear if his rating of 0 is SC or NSC...

@Whodat In related news, the Supreme Court is taking a look at an appeal which involves the troublesome Chevron deference ruling: https://www.cnn.com/2023/05/01/politics/supreme-court-chevron-deference-conservatives-power-of-agencies/index.html Imagine if unelected government officials had to follow the laws as written instead of being able to make their own policies which carry the weight of law. A lot of the red tape regs in the VA could be impacted, including at the BVA level...

@Whodat I agree. Before COVID hit, I recall being told by a couple of individuals at the VBA that all paper records have been scanned in to make searching much faster. However, unlike many private sector companies, the VA failed to have a contingency plan in place to facilitate telework, so they had to catch up. The VA is supposed to be hiring thousands of new employees and training existing employees to speed up PACT Act claims. I had my VA primary care checkup last week and the doc asked if I was ever exposed to any potentially toxic substances, so the screening is beginning. That probably will have no effect for me because I am already 100% P&T. While in the Army, I remember the supply SGT bringing me three staplers and a bunch of other office supplies I did not need. I asked why. They said that they cannot order more if they were still in the supply cabinets. If they end up ordering less then their budget would be cut. They had to have a plan to keep requesting higher budgets each year. What is happening at the VA is similar when you look at the increased budget levels year after year. Every few years there has to be some new priority to be placed ahead of existing priorities which simultaneously helping to justify an increase in budgets.

@Infantry 1Sgt I hope I am lucky enough to get my BVA appeal handled by the same judges who reviewed yours. Crossing my fingers that you get a good outcome from the remand.

@Whodat My video hearing was in December 2022 for an error made in 2000. My VSO said I should get a decision in about six months. However, I knew that likely won't happen due to legacy claim and other priority groups. It would be great to get a proper decision based on the laws in effect at the time my initial decision was made, but I realize the legacy, over 75, terminal, and hardship cases should indeed come before me. Hurry up and wait...

If you have a POA with a VSO, you could ask them to look it up and see if they can provide you with a more accurate idea of what is going on. They should be able to provide you with a copy of the decision letter if it is ready.

Not sure if it would apply to you because you were a civilian, but here is an information sheet from the VA. Good luck though! https://www.va.gov/resources/the-pact-act-and-your-va-benefits/#:~:text=The PACT Act is a,by exposure to these substances.

Is that from the time you initially filed a claim or from when you appealed to the BVA? My VSO estimated it would take six months after the BVA hearing I had in December 2022. I honestly believe a decision in my appeal will be ready in 2024 or 2025...

@USMCNASA Congratulations on your win! Reaching 50% is great. You can get VA medical for non-SC issues, plus no more co-pays. Just be sure to contact the VA business office and ask that they do a review to see if you are due any co-pay reimbursement!