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Berta
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Aloha from Hawaii Ms. Berta,
I need your assistance on drafting up my NOD for my clothing allowance denial letter. I have pdf my clothing allowance denying my Lower Back Pain Brace redacting personal info. But, I have to ask for assistance first. I have done my research per to the requirements of the Website, and don't want to hijack other members post. I humbly request your guidance.
History/Summary:
The VA Prosthetic's sent me a denial letter saying that my Lower Back Pain (LBP) Brace isn't on the list of approved devices.
I have been receiving clothing allowance since I have filled. I've always been fitted for my LBP Brace, and always received a rigid back brace that has two parts. Then one day I went to the brace shop to get fitted and was informed that the individual who does the LBP Brace fitting wasn't working. I left and 2 days later I received a brace in the mail from the VA Prosthetics. The New Brace they sent me was much smaller and it's a one piece LBP Brace. I said to self well try it out, I liked that it was not as bulky as the 2 piece LBP Brace I have been receiving. Tried it and noticed that it wasn't supporting the region of my Back where I have alot of pain. I tried this for a year and then I informed my Primary Care Provider about the New LBP Brace wasn't adequate. My Provider gave another consult to go to Prosthetic's to get fitted. And the same thing happened. Prosthetic's informed me that the Brace fitter guy was in a meeting and come back after lunch, but it was only 0900 hrs. I came back after lunch and was informed again that the Brace fitter guy was not here, so I left. Then 2 days later I got the same LBP Brace that did not work for me.
Then this happened. I received my Clothing Allowance letter, stating that my clothing allowance is being reviewed, then while I was trying to get fitted, I guess it triggered Prosthetic area to act on my case. Then a days later I received my denial letter specifying that my LBP Brace is not on the list of approved devices.
The 2 part LBP Brace I was fitted for was on the approved device list.
The New LBP Brace was the standard off the shelf, was not on the approved device list.
Sorry for the long windiness.
Thank you for any guidance you can provide.
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Please post this as a new topic in Claims research forum.
I have limited internet due to weather- so others will help
You might be able to resolve this sooner than later with an IRIS complaint- others will tell how to do that-
Also if you scan and attach the denial to your post ( cover C file # , name) there might definitely be a CUE in the decision. There is plenty here on CUE.
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Ms. Berta,
Thank you for your response. I have posted the letter sent. I appreciate your advice on this matter. I didn't even have a C&P by a physician. Prosthetic just sent me a denial letter. I guess I was worried about sending in my NOD and keep it as simple as possible, so that it can initiate the SOC or maybe a C&P. I've also got up to speed with the new claims procedures. Thank you for your advice.
Date: November 30, 2018
Dear Mr
The Department of Veterans Affairs may pay a clothing allowance(s) to Veterans according to Title 38 U.S. C. 1162. In order to receive a clothing allowance(s) one must have met one or more of the following:
Service-Connected disability(s) or condition(s) that requires you to wear or use a prosthetic or orthopedic device(s)/appliances(s) that wears out or tears clothing (e.g., pants, skirt, shirts, blouse, etc.) Service-Connected skin condition(s) in which medication(s) is prescribed by a physician which causes irreparable damage to outer garment.
Your clothing allowance applications for 2018 was received and processed. The bilateral knee braces you employ impacts lower articles of clothing which qualifies for two clothing allowances. The other items indicated: Back brace, orthotics, and Aquaphor is not on the list of approved devices/medications, and do not qualify. As a result, they have been denied. You will receive payment in the amount of
for 2018. VBA will send you a letter on or about July 1, 2019 with instructions on how to apply for next year's clothing allowance. The application must be received on or before August 1, 2019; to be processed on time.
What you should do if you disagree with our decision If you do not agree with our decision, you should write and tell us why. You have one year from the date of this letter to appeal the decision. The enclosed VA Form 4107, "Your Rights to Appeal Our Decision, explains your right to appeal.
Sincerely,
Prosthetics Representative Enclosure: VA Form 4107
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