Ask Your VA Claims Questions | Read Current Posts
Read VA Disability Claims Articles
Search | View All Forums | Donate | Blogs | New Users | Rules
brokensoldier244th
-
Posts
3,528 -
Joined
-
Days Won
121
Content Type
Profiles
Forums
Events
VA Disability and Benefits Information
VA Benefits News
Store
Posts posted by brokensoldier244th
-
-
1 hour ago, glashutte said:
Do you mean when the VA tried to bill private medical insurance or Tricare for medical procedures?
Or do you mean if I have SC GERD, go to my civilian PCP through private insurance and get seen for GERD, then the VA will track that since my GERD is supposed to be seen at the VA?
It's not 'supposed to be seen at VA...' you can see whoever you want. We don't have timer to track that stuff, frankly most off you aren't that interesting. I read several hundred pgs a day about 5-10 veterans a day. Honestly, other than a few cases most of your information leaves my head the second I turn off my computer and go upstairs too the living room to play with my min pin.
-
1 hour ago, glashutte said:
I thought I replied but guess it didn’t go thru.
What about disability thru private insurance? I had a bad injury recently (broken parts) and was out of work but did not claim it in fear of any cross communication between insurance company (Mass Mutual) and VA. Then VA would think I’m double dipping or something ridiculous
Again, the two aren't related. Two different sets of records, two different sets of privacy rules
-
Roadside assistance/toll fees are state. Nothing to do with us. Requesting decision letters goes through public contact, nothing to do with claims. We're don't access medical records unless it's part of a claim, it's a violation of privacy laws. We have to have release from you to log into VHA, And it's tracked.
- ShrekTheTank, Vync and GBArmy
-
3
-
He asked for where to get help. It was provided. If he isn't comfortable with technology he can get a VSO to help him.
You are right, we're don't know. Why assume he doesn't know how to look things up? He found this site, didn't he? He was given some directions to go in, we can't work his claim for him.
You suggested, after all, that he could represent himself. That would require research.
-
His percentage is in his profile Icon next to his name on the left sidebar.
-
A VSO is going to be your best bet, they are usually local. DAV, VFW, Amer Legion, etc. There are some Facebook groups that good as well, I moderate or help out in a few. VA Disability Q/A is a good one. There is also Reddit, but that is a bit 'wild west' with a lot of complaining- justified and not, and it gets kinda toxic in some of the areas, so, googling for that would be at your own risk.
-
That's because we're don't have any training or guidance on it yet. It wasn't signed until this morning.
-
-
Yes. The original claim is not adjudicated, i.e. as a claim- there is no rating decision as the claim is barred wither regulatory or by statute. An admin decision is made barring benefits, unless eligible for Chap 17 benefits, but thats only health for the specific contentions.
-
We can't just hold claims for 2 yrs. We have to evaluate based on whatever current regulations are at the time they are filed.
-
Not yet- it just passed the other day. We still haven't gotten guidance on how it will be applied because, up until yesterday, it was a no-go (again.....)
- Max Rommel and Vync
-
2
-
It's not just physical, the psych is wrong.
-
It will take a 40-50% to get over the hump. You are 10-ish% able ( depends on the actual percent not the rounded number) so a 40-50% of 10 is 4-5, added to your current rating, which should put you over.
Do you have neuropathy, too? That adds to the rating also. For an initial back rating they are supposed to account for that also, if it's in your records. If you have it in more than one extremity you get a bump, also due to bilateral factor. You can appeal with a supplemental (21-0995 or 0996). Difference is with an 0995 you can add new and relevant evidenced. An 0996 is just a higher review of the existing evidence.
-
-
No worries. Sometimes I get thanks on the down low- sometimes I don't. It's okay, for the most part. I started out as a vet on the outside for many more years than I've been at VA. In fact, ive only filed one claim for a minor increase since I started working there (other than dependent stuff with my kids aging out or going to college, etc) that ended with a denial- but I understand why now, after several years of wondering why my sleep apnea rating was only 20% and not 50%*. I try to pass that same 'lightbulb moment' stuff on to you all. I learn stuff every week that I didn't know, because even with 4-5 months of training to start there is no way in HELL you can learn everything. There is a very large component of 'don't know until you run across the scenario....'. They told me when I got hired that it can take 2-3 years after training to start feeling comfortable doing the job. I about freaked at the time when I asked about that in my interview. Now I understand why.
You all, many of you, are piecing it together in snippets just like I was doing, and I know how frustrating that is, so I try to help out with information when I can. I never get to see the end result of the claims I work on unless I go look them up again several months later to see what has 'closed out'. At least in here there is more direct feedback- and some of you know way more than I do just from your own experience, or from having worked at VA also, so I learn stuff here too.
* its convoluted, but I can explain it if someone is interested- you can DM me
-
-
The presumptive is for currently serving, or recently discharged (like, a few weeks after discharge) veterans. This regulation change doesn't affect anything with other veterans or the process of filing for a claim for them. You would have to establish how the Covid and an SC were connected, just like a normal claim.
-
Rick- if your examiner checked Total social/Occupational Impairment that goes a long way. While its not a slam dunk (it never is, is it *sigh*) it helps a lot. Remember- Total and Social occupational impairment does not need to have ALL the things listed under it, a number of them in any combination will suffice. 100% doesn't mean we are vegetables, even with MH ratings. VA recognizes this, finally, and there is something working its way through the Federal Register that seeks to address this by changing some of the rating criteria for MH. Among the changes being proposed (NOT finalized yet) by McDonough are removing the 0% rating because what the hell is that, anyway, and removing the language about total occupational impairment from the 100% rating and not being able to work.
A 100% combined veteran can work (within their limitations, of course) there is no reason that a 100% mental rated veteran shouldn't be able to, either, especially since our economy has shifted pretty far away from manufacturing and agriculture, and being in an office 8 hours a day as a requirement. As an example, I'm 100% rated combined and heavily on both the mental and physical side, and I work from home 8 days out of every 10, and soon, hopefully, all the time. I can mitigate my 'low' days, migraine days, pain days at home in a comfortable, safe, quiet, and familiar environment with my kids and wife, and cat/dog around, and take as many breaks as I need to as long as I get my 8 hours in out of a 12 hour duty day period. My propensity for distrac ....SQUIRREL!!!....tions is reduced because I don't have Joe and Charlene discussing the Bachelor over there, and this dude over here humming off key to Broadway Favorites NOW Vol 12. McDonough (Sec VA Affairs) is on record agreeing that 100% doesn't mean useless, and Total Occupational and Social impairment doesn't mean the same thing in relation to the working and social world that it used to.
How many of us on here have MH issues and PTSD, and manage to converse/relate to each other more or less daily IN THIS CONTEXT where, if we were in a coffee shop we'd be scanning for exits, or avoiding people in the corner so we don't get overwhelmed- and that's if our social anxiety or propensity for distractions let us get out the door of the house and safely drive somewhere in the first place? See what I mean? MS Teams, Skype, FB, VOIP, broadband, and email that allows really large attachments (for work) are pretty normal for a lot of people now.
On to claims and who works them.
The short version- Claims have always been somewhat segmented between VSRs based on what the primary driver of the claim is. It just makes things easier and faster if the trained people or those with more time in do certain things
The longer version-
Claims have always been broken up into teams, at least in the last several years. Any RVSR 'can' rate most any type of claim and any VSR can work a claim- unless it is a Camp Lejeune, some kind of Radiation Exposure, AO, MST, Nehmer- those go to certain RO's designated as primary rating ROs for those types of claims- The RO I am in does 'normal claims', but is also a designated RO for Nehmer and MST. We have a large team that handles "VSC" claims (veterans service center- VA speak for an RO) that are general- hips, back, acne, optical, chronic pain, whatever. You know, 'normal' claims. But then we have a team specifically for MST, Navy Blue/Brown Water, Nehmer, and thats all they do.
As an MST team/Blue/Brownwater person I work MST claims, though they often come in combined with other issues, so I work the whole claim, since we were all trained originally to work regular claims. The MST portion is a separate bit of training that I had specific to those types of issues and I also can work regular PTSD claims and stressor research as well since, at the end of the day, PTSD is PTSD. The process for researching the stressors isn't all that different for one or the other. I may spend a few hours pouring over deck logs, newspaper searches, obituaries, personnel/STR for a combat PTSD claim, whereas, for MST I will do the same but also be privy to police reports, CID, NCIS, shore patrol, whatever. The repositories of information I look through are somewhat different but the process is the same. I put on my glasses, grab caffeine, put on my headphones, and dive in. When I was hired it was for Blue/Brownwater claims and I did those for about 8 months on my own before transitioning to where I am now.
Originally (like, prior to 2 or so years ago) MST claims could be worked by anyone, but a rather damning OIG report (justifiably so, Ive read it) showed that they were being mishandled. Information was being missed for behavioral markers and stressors, VSRs were missing variations of 'medical speak' for certain issues that might present themselves in a sexual trauma claim where the doctor weren't using 'standard medical speak, VSRs weren't developing completely for stressors to civilian or federal law enforcement for investigative reports, they weren't noticing behavioral shifts in STR and Personnel records. Thats when VA National chose 5 RO's to work them specifically, based on a multiyear average of accuracy and output of completed claims. Soon MST claims will be consolidated again down to 1 RO where that RO will pretty much only work those claims. A recent OIG report showed that there were still errors being made on MST claims, but a sizeable fraction fewer than what was happening before since the shift to specifically trained people. Other reports that I have read about Nehmer/AO, etc. say similar.
Our RO has authorized several hundred thousand dollars worth of Nehmer and MST claims just in the last few months that I can remember off the top of my head- to veterans, not just survivors, because we caught a lot of errors or found evidence buried in some PDF from NPRC, deck logs, day logs, mission AARs, NCIS, Mayberry PD, that was missed before. That comes from training, familiarity, and a general sense of personal pride at our overall national ranking. Some other RO's hate mine because we overturn errors that they make and send the claims back to them to get fixed, or overturn their errors on US because they weren't actually errors in the first place). We work really hard to maintain that.
Ok- Ill shut up now.
-
If you have a vso they can see the claim directly- the phone people can only see the comments we leave.
-
"Regular" PTSD can be reviewed by any VSR, and any RVSR, though generally the PTSD claims as a whole go to certain teams of RVSRs depending on what they are for. Mostly thats just so they can be more easily tracked, and so those of us with more experience in certain areas work more claims in that particular area. 2 months at "Prep" seems a bit long, though, unless they had to request records from NPRC or something, or are waiting on prior employers, private medical records, stuff like that. Did you file for IU? that can take longer, too.
MST (sexual trauma) PTSD claims, though, they only go to certain groups at 5 RO's right now, and each of those teams specifically is about 20 people or so, because we have had different training from the start, and ongoing, for working with these. They take longer because they are a lot more nuanced, and require a lot of back and forth with short patrol, CID, local investigative agencies, whatever.
-
3 hours ago, brokensoldier244th said:
You can only get dependent pay for a Spouse on Chap 35. Children dependents must be removed from your award or you will incur an overpayment.
(2) means for subsequent children, not concurrent receipt of benefits.
also, pg 5
Chapter 35 – Eligibility
• If dependents enter active duty, Chapter 35 benefits are
suspended
• Dependents can receive Chapter 35 and be on Active Duty
Training for Guard/Reserves
• Children can’t receive DIC (Dependency and Indemnity
Compensation) and Chapter 35 concurrently
• Spouses can receive both DIC and Chapter 35 benefits
• Child receiving Chapter 35 is removed from the parent’s
disability check ( spouses can remain on veteran’s check) -
You can only get dependent pay for a Spouse on Chap 35. Children dependents must be removed from your award or you will incur an overpayment.
-
You need to change the status of your dependents to remove them from your award, 21-686c. If you wait for it to trigger automatically you will likely end up owing overpayments back to VA because the removal process isn’t instantaneous but it’s a lot faster if you do it vs waiting for it to happen on its own.
Champ Va is different and you certify their enrollment with then independent of your award dependent status.
/two kids who have used chap 35, one about to start in Aug.
- flow1972, ShrekTheTank and Vync
-
3
-
The two terms are synonymous.
Avoiding VA Contact
in VA Disability Claims Research
Posted
You telling the VA they can't bill your insurance is funny- because they don't have to listen you at all. They are required to recoup costs, and their billing your insurance satisfies your deductable so it's not hurting you. Legally, they are required to bill if you have insurance on record. I really don't see the problem.