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  1. HLR for EED was returned for duty to assist error based on; 38 CFR §4.70 Inadequate examinations. The Higher level review return says that the c&p examiner did not specifically address the board remand directives even though the c&p examiner did specifically and explicitly address all of the noted board remand instruction directives. They are questioning all of the basis that the original C&P examiner gave that the VA used to grant the increased evaluation of 100%, even though it was clearly sufficient. They are questioning the diagnosis, the frequency, the symptom severity level, and the duration. What are their options to reduce in this scenario? Difference of opinion? Cue? Reduction process? Can they bypass all of those option and just re adjudicate it at a lower rating because the decision was less than 1 year ago? Does this mean that the favorable findings laws and cue laws don't apply and that they can just issue a new rating decision to revise my 100% rating without any CUE or reduction due process?
  2. Submitted HLR on july 15 informal conference sept 1, sept 9 received duty to assist on the sleep apnea claim. nov 10 there was an ace exam was told they may call me for the review, no call happened. It hasn’t moved since sept 9. What happens next? how long could it be first HLR with duty to assist. Thank you
  3. sleep apnea secondary to ptsd Good afternoon all. I had a question about a higher level review that returned a duty to assist error. The VA determined that they did not take into account all the medical studies I uploaded as well as an IMO from a pulmonologist stating that my sleep apnea is more likely than not caused and aggravated by my service connected ptsd. The senior rater who determined that the VA must provide me C&P exam and the examiner must take into account the IMO from my pulmonologist as well as the studies I uploaded. Is fast forward to a couple weeks ago and VES Set me up for C&P exam but it was an Ace review. I received my results last week by calling The regional office and they stated that the examiner stated that there is no evidence that that sleep apnea and PTSD are connected And that my sleep apnea is less likely than not connected to my service connected PTSD. How can the examiner say there is no evidence when when I uploaded about 15 different studies connecting the two, some of which were from the VA themselves, as well as a board of veterans appeals ruling connecting the two? It seems that the examiner didn't even follow the senior raters instructions to take my evidence into account because he stated "no evidence" linking the two and did not refute the studies...so i filed a complaint with the white house hotline and the 1800 number and told them that due to the verbage in the examiners notes it seems he did not even address the duty to assist error and that i am requesting a new IN PERSON exam so i can make sure the examiner reviews all medical evidence/studies/imo from my specialist. Is it possible that they will set me up for a new c&p before closing out the HLR?
  4. Hello all. Hopefully an easy question as I can assume that there are a good number of people that have questioned this, and have gone either way, when appealing to a Higher Level Review (HLR). When I fill out my paperwork for a HLR, should I check the box and ask for an Informal Conference? Should I just submit a statement? Should I do both? I have heard good arguments for, and against, the informal conference. Some say it's better to speak to the rater to make your case and make sure that all the evidence was looked at. Others say that It's better to submit a statement making your case because the rater can't look at the claim until you're on the phone with them if you choose a conference, and that you may inadvertently say something that goes against you, and the HLR will take longer if you select the informal conference rather than submitting a statement. I'm not sure if all that is true or not. I'm leaning toward doing both, but am not sure as I don't want to delay my claim any longer than it needs to be. Any advice is much appreciated!
  5. I went to the VA Medical Center today to talk to the Veterans Benefits Adviser about my claims and to get a copy of two of my denied C&P exams. The first question I asked was why my secondary "intermediate-step" claims that I submitted were denied at the initial level. He looked at me an said "what's that?" After I explained to him what an intermediate-step claim was, he told me that he had never heard of that before. I asked if the raters at the Higher Level Review (HLR) would know. He said he had no idea. So, am I missing something here? They're supposed to be the experts. Last week I spoke to another advisor in the same office who told me that I wasn't eligible for TDIU because I didn't have the required percentage. He then (incorrectly) quoted me the requirements. I told him he was incorrect, but he was steadfast. I wonder how many veterans have been affected by their misinformation? Am I wrong in thinking that the VA purposely doesn't inform, or properly educate, their representatives about everything so that they don't pass the information on to veterans? Plausible deniability? MY OPINION: if a veteran is not self-educated about their claims, and relies solely on the "expertise" of VA representatives, they're screwed. In my humble opinion. Am I wrong? Has anyone else ever run across this?
  6. Greetings fellow vets, I'm getting ready to submit my "intermediate-step" secondary claims, that the VA has denied, to a Higher Level Review (HLR). Does anyone know if the senior claims raters at a HLR will consider an "intermediate-step" link in their decision? Or will they just deny the claim when they can't directly link it to service, like the initial claims raters do? I know the BVA will, and does, recognize the "intermediate-step" in secondary claims, but I can't seem to find any answers on the internet whether or not the HLR raters do. I'm just wondering if I'm spinning my wheels, or not. Hopefully someone has first-hand knowledge of this. Thank you for all replies.
  7. As of today, my appeal was officially closed. Overall I won. I was granted 100% P&T, even after some additional exams. However they effective date only went back to July 2020 (date of my last c&p), I originally submitted in November 2018. So missing close to 2 years of pay. The supplemental claim which this appeal was based on did grant me a couple items, which were dated all the way back to November 2018. That decision stated this was because the claim was continuously pursued. My appeal was filed less than a month after the supplemental decision, so in a timely manner. This appeal implementation decision did not use that logic and decided the date of the c&p was the first time they had evidence (I was given 0% rating from November 2018 to July 2020 on most items). Now the question is do I HLR and try to argue they used 2 different methods to determine effective date based on the same evidence, or take it right back to the board? one guy at DAV said take it to the board so they don’t mess with anything else, but I’m not sure if there is any truth in that.
  8. Morning All, My Questions in this post are somewhat tied to my post of Feb 8th. I really appreciate all the input I received on that post. I've been really struggling on how I should proceed with two of my secondary claims (OSA and Hypertension) that were denied by the VA. Especially the OSA claim. And here's why... For my C&P exams for my Hypertension, Back Issues, Bilateral Radiculopathy, Abdominal Hernia, and OSA, the VA sent me to a Physicians Assistant (PA). The PA checked all of these claims in one appointment and hardly asked me anything about my OSA and Hypertension. My claim for Radiculopathy ended up being granted and I received an increased rating for my already service-connected (SC) back. However, the other claims were denied. Just to be clear, as I believe I noted in my Feb 8th post, I submitted the denied claims as secondary claims to my SC lower back using my obesity (caused by my SC back issues) as the "intermediate step" to these secondary claims. On a side note - I was given a C&P exam by a different PA, on a different day, on my knee. This was also a weight-related secondary claim that was denied. So, so far, the VA has denied all of my secondary weight-related claims. In any case, I have been seeing a Sleep Specialist for my OSA, who wrote a Nexus for me that I submitted with my claim. In fact, every claim I submitted I had a Nexus for (from Doctors - not a PA), as well as sufficient medical records. And yet, the VA chose to take the word of a PA over a Specialist. On a good note (at least I think) the VA did acknowledge in their decision letter that I did in fact have OSA and Hypertension. Is that a good thing for me? Even though I have four claims that have not been rated as of yet, that I sent in at the same time as the ones mentioned above, the VA sent me a decision letter for the ones that have been decided. The claims I'm still waiting on three claims that fall under the mental health category, and my TDIU claim. So I'm not sure if the VA already knows they will deny them, or if they realize it will take a long time to decide, so they went ahead and sent a decision letter. Doesn't make sense to me that they would send a decision letter when I still have undecided claims out. Thoughts on this?? Anyway, my main questions are: 1. For my OSA claim: should I get a DBQ from my Sleep Specialist and file for a Supplemental Claim, or no DBQ and just do a Higher Level Review (HLR)? This is the question that's had me tossing and turning the most. 2. Should I wait for all my claims to be decided before I file for a Supplemental or a HLR on my denied claims? 3. Should I file all denied claims at the same time, or stagger them? I'm mostly concerned about my OSA and Hypertension claims getting approved. If any of my conditions kill me, it will likely be one of those two - and I want to make sure my wife has a good chance at DIC if it does. Thanks again for any inputs and advice. It's much appreciated!
  9. I know this may have been discussed previously, but here’s another example. I was service connected for heart conditions at ten percent. I appealed the percentage and also put in for IU. I U was denied and the percentage was not addressed, so I submitted a HLR to address the percentage. I got a message to contact LHI for a C&P. Called them a moment ago. Turns out VA is asking for an IMO on ALL my prior claims. These claims are ten years old. Seems kind of strange? Doesn’t it? HLR updates say a decision was made on 10/15, then it says an error was found the same day and they are fixing it. Not feeling too confident about this news.
  10. I submitted a claim back in March of this year. Was denied after a less than favorable C&P. None of the issues during my service that I discussed with the examiner were in the DBQ. He basically blamed everything on personal life before the military, even though there are and were no issues before my time in service. I received this letter in September and somehow it sat on my desk until this weekend unopened. I redacted personal information and am attaching it to this post. Can anybody make sense of this for me? The examiner did state during my examination that he saw no evidence of a personality disorder in my records, even though I submitted a photo copy of the diagnosis straight from my service record. During the HLR conference call I informed the representative of the many things left out of the DBQ, and the fact that he (the examiner) said there was no evidence in my records of the disorder. Does this look like good news? Bad news? No news? I'm glad I opened the letter so late. Saved me a month or so of stressing over all of this.
  11. Does anyone have any idea how long DFAS Audit take when you see compensation issue on the website or are there any other indicators to look for that tells what is going on with the HLR? This was a HLR for an EED based on CUE. The claim states a new decision has been made but in typical VA fashion I cannot get any information yet! Looking for some insight!
  12. I have roughly one million questions but I'll try to keep it simple. This is the first time I am appealing a denied claim (though not my first denied claim - I currently have 50% combined). Almost exactly one year after my C&P exam I finally got a denial for both of my knees). I did a HLR informal conference and now my va.gov status says "The VBA is correcting an error". Here is the decision I received on Dec. 7th after the Higher Level Review (sorry I couldn't figure out how to add image) and below that are my questions. Decision: 1. A duty to assist error has been identified during the Higher Level Review of left knee pain. 2. A duty to assist error has been identified during the Higher Level Review of right knee pain. Evidence: Timeline from intent to file on 10/2/19 to HLR informal conference on 12/2/20 Reasons for Decision: 1. Higher Level Review for left knee pain The issue of left knee pain was returned for correction of a duty to assist error in the prior decision. We failed to get other records. We will develop for lay statements and if warranted additional opinions. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159, 38 CFR 3.2502, 38 CFR 3.2601) Favorable findings identified in the decision: You have been diagnosed with a disability. The VA exam dated 11/7/19 showed a diagnosis of patellofemoral pain syndrome. 2. Higher Level Review for right knee pain The issue of right knee pain was returned for correction of a duty to assist error in the prior decision. We failed to get other records. We will develop for lay statements and if warranted additional opinions. (38 CFR 3.303, 38 CFR 3.304, 38 CFR 3.159, 38 CFR 3.2502, 38 CFR 3.2601) Favorable findings identified in the decision: A nexus or link has been established between your claimed issue and an in-service event or injury. During VA exam dated 11/7/19 the VA examiner provided a positive medical opinion linking your right knee to service. You have been diagnosed with a disability. The VA exam dated 11/7/19 showed a diagnosis of right meniscal tear, right knee instability, and patellofemoral pain syndrome. MY QUESTIONS 1. Am I just out of luck because I didn't seek treatment during Active Duty? 2. Under "favorable findings" it states that "a nexus, or link, has been established between your claimed issue and an in-service event". Isn't that the literal definition of a service connected disability?! 3. What is the error? What have you all seen as timelines and outcomes for this? Thank you to everyone who takes the time to respond and post. Reading these questions/answers over the last year has been both educational and comforting.
  13. Good afternoon. Was checking to see if anyone had any insight to what might be going on. Last night checked my HLR appeal status and it says it was closed. Not that a decision was made, not that anything was sent out, only to contact VA or VSO. My issues are no longer listed. I had my informal conference a week ago. Thought it went well. She said it should probably close last Friday or this past Monday, but it closed a week later. Being it is the weekend, not sure what to expect. If anything should be updated yet, or if to expect any changes anywhere this quickly.
  14. Hi all, Hoping some people can assist me in next steps. I've recently WON my High Level Review to get the VA to say my Inguinal Hernia IS service connected, but it was rated at 0%. Looking online it says that "Hernias that have not been or cannot be repaired are rated at 10 percent disabling. Importantly, a 0 percent disability rating is given for repaired and healed hernias; however, if there are lasting symptoms caused by the hernia (e.g., decreased organ function or muscle damage) they are rated separately." Since my hernia is still not repaired, shouldn't it be at 10% and not 0? Questions/Comments/Concerns please let me know. inguinal hernia 0% Service Connected 09/28/2020
  15. Hello all, I Had requested an HLR due to C&P not performing a proper evaluation on my legs. Also as part of that there was a request to fix the PTSD error (which was listed as only Major Depressive Disordered) and PTSD was listed in the findings as not service connected. VSO said they should be linked as its the same event, so during the HLR request we asked that PTSD be granted as my records show I have PTSD due to specific events. I Have received my letter stating I am 100% P&T, but also in the letter it states a duty to assist error for the PTSD. I had gotten a call last week to scheduled a new exam for the PTSD, should I be worried? Should I even go to the exam? I am at a loss, after so many years fighting I am now P&T, and it felt like the world had lifted from my shoulders, but now its all back again. Any advice would help.
  16. So, I had an HLR initiated awhile back. There was a DTA and I was sent to new exam on 3/23. The rating came in today on Ebenefits (I know, ickk, waiting on BBE). EED shows 2018 on my two awards for DDD in lumbar and radiculopathy on left side. Problem is, the HLR decision received explaining the DTA error that gave me the new exam stated that the condition would be presumptive to 2011. I feel like maybe the person rating did not quite see that part of the claim and went with my original intent to file date? I notified my attorney of it, maybe they can see it in system. However, with COVID they have been having a lot of......employee turnover at my attorney firm, so it has been more difficult to reach them timely than normal. Just trying to see if I misread something or not. Below is a link to the timeline I have been keeping of this claim as well as the HLR DTA error decision from Nov 2020. Thanks
  17. - Completed conference call for HLR - Person was very helpful and professional, said something like "finish up today or tomorrow and after that expect to receive a letter in the mail a few days later." - Checked Ebenefits and VA.gov and ratings did not change. - VA.gov shows the claim still being worked on for HLR. - Currently at 90%. - I called the VA 1800 and they said something like "we cant talk about details until 10 days after a decision letter gets sent, but I can see they are still working on the claim" - I couldnt find anything online about what happens after the reviewer hands it off. - Any champs with insight on what happens after the phone call that takes 2 or 3 weeks time?
  18. ******UPDATE---4-13-2021******* I received my decision letter for my duty to assist (although I never did receive a full explanation on why a duty to assist was flagged or what basis and I think I never will)...they note that from my C&P exam, my symptoms are: pyrosis (heatburn and/or reflux), regurgitation, substernal pain and vomiting, and the decision is to continue my GERD rating at 10%. I don't know what else to do here. Shouldn't I be rated at least 30%, if not 60%? I mean, there are times, (as I told the C&P examiner), that I have had to come home from work to take medicine or reschedule a meeting during a flare-up because, ya know, belching etc., isn't professional. My examiner wanted to hear none of it. Did not even look at my file when I tried to show him all the documentation that this has been going on for such a long time. Now, a week later, I get a decision letter that it is to be continued at 10%....Any suggestions? Should I do a CUE at this point?.... ***NEW UPDATE-April 3, 2021 Okay, so I received a letter about the duty to assist for my GERD claim, and scheduled a C&P. My file online for disability claims also updated to show the GERD claim. I went to my C&P exam this past Wednesday, where the claims guy went over the whole sheet about my symptoms and whatever for my GERD. Then, on Thursday, it updated on my disabilities page-except now it says PTSD claim? Same thing yesterday, it says, "what you've claimed-PSTD, claim received March 31st (when I had my C&P exam". Who do I contact about this error? OR do I wait for them to catch it? It still says it today (obviously, since the VA is closed). But, all the way up to this point, it HAD said GERD. It also has listed my GERD files stuff under the files section of the claim....... *****NEW EDIT AS OF FEB. 14th.... Okay, it says that the HLR review was completed on Jan. 28th. I STILL have not received a letter, and on Monday, the 15th, it will be three weeks. The rating looks to be the same on my e-file, but, when I called the VSO on Friday to see if he could see anything on his end of what the VA said about the HLR, he said that my file showed nothing-not the claim or my disability percent(s), or the HLR. Anyone else run into issues with HLR decisions and taking longer than the 10 days to receive your decision letter? I would like to know why I was denied (I am assuming I was, since the percent is the same)... Thanks everyone!! Good Afternoon, I know the time frame for a HLR is normally about 4 months (they state on their website 125 days), however, I am wondering if anyone has filed a HLR since they opened up the VA more in August? Just wondering if there is a huge backlog now. I have mine just sitting there since September, and no status change, even though I was thinking it would be until January, but, as most others have said, still checking often to see if there has been any updates! Thanks!!!
  19. In August 2020, I filed a HLR for heart attack and was just called by a DRO. The DRO indicated the decision was in error because it was based solely on the wrong condition (atrial fibrillation) and did not address the heart attack at all. They will go over everything, including the strong "more likely than not" IMO from my non-VA board certified doctor. They said they would try to grant based off of the evidence of record. Of course, if granted, I would get another heart C&P for rating purposed. Should know something within the next couple of weeks.
  20. I will upload this to the HLR timeline post I have but also wanted to get some input. Looks like my supplemental claim about the lack of secondary opinion helped get me new CP exam as this is what the error was in my claim, apparently. It seems like they may back date the EED also to my ETS, at least that's how it seems to read? Any input is appreciated. HLR Decision - Error Correction_Redacted.pdf
  21. Hello all. This is my first post on here. Looking forward to learning as much as I can from all of you and sharing my experiences. I was recently awarded 100% disability with SMC-S. I believe my lawyer wasn't satisfied with the outcome because the claim did not have any back pay. Meaning there was no payment to them. I understand that. Everyone wants to get paid for their work. It took 2 years of work and they received no payment. They filed for a HLR to raise my PTSD rating from a previously denied decision almost 3 years ago. I was rated 50% 3 years ago for PTSD and they're trying to argue that it should have been 70% so my rating would have been 100% overall. I don't know if it's a good idea to push for more after getting the award I received. I want to make sure they are not risking the benefits I've received by trying to get some type of payment. I don't know if the HLR will cause them to look over all of my disabilities again. I am happy with the decision and would like back pay but not at the risk of my status now. I've asked them if it's a risk but not sure if I should believe it, because if I they don't push for this the time they spent on my claim would give them no money. Thank you in advance for any advice all of you can give.
  22. A higher-level review of your claim was conducted on ..., the issue of degenerative disc disease, lumbar spine (claimed as back), was returned for a duty to assist error. The decision review officer (DRO), returned your claim for the additional medical examination and opinion to answer the question of wither [whether?] the Veteran's claimed condition which existed prior to service was aggravated beyond its natural progression by the claimed condition ... Problem is that the Veteran's claimed condition is "Service connection for degenerative disc disease, lumbar spine (claimed as back) as secondary to the service-connected disability of left ankle osteoarthritis". Since it is based on a service-connected disability, it cannot have "existed prior to service". Does this meet the criteria for a CUE?
  23. Got my HLR call Saturday. Yes, Saturday. Hard to believe that someone in the VA is working on Saturday. Good thing the phone displayed VA or I wouldn't have bothered to answer it. I submitted my HLR back on 2 June 2020. Her call was on 24 October 2020. 144 days. The VA will definitely not make their goal of 125 days to the decision on this one. I am not sure what she had looked at in my case, if anything. She wanted to know what I was disagreeing with. I explained to her about the CUE I had filed, all the trouble I had getting VA to accept it. I explained to her how the VA had requested C&P exams when all I was trying to do was get the VA to look into a CUE. I explained to her how since the VA had done C&P exams the rater had put in the effort to communicate with the examiner twice to reduce a rating from 40% to 20%, yet the examiner couldn't find my SSA grant. I explained to her about the SSA records in my C-file, how I had about 20 pages of someone else's records in the middle of my records. I told her maybe this is part of why someone didn't approve it sooner. I told her it looked to me like someone dropped the paper files and didn't have enough sense to separate the two files. I told her about the latest denial where the rater looked into the SSA records and found a denial but didn't look up the grant of benefits that is in the SSA records. I explained to her that I hadn't worked since June 2000. I told her about the VR&E denial based on my doctors statements. I told her how the raters kept denying me stating other evidence in my records showed I wasn't unemployable. I explained to her how the raters kept saying I quit my job, but M21-1 says that doesn't have any affect on the decision. She seemed very sympathetic. She said she would take care of me. Well, it will be very interesting to see if she does. I had a prior call from a lady at the Roanoke VA, she thought I was going to get approved. In just a few weeks I got the denial. I had written to my congressman about all this crap. I got a reply back from the congressman's office but it was the same BS from the VA. I sent back to the congressman's office quite a few pages of all the documentation showing the VA crap. I think this was sent by the congressman to the VA Secretary Wilkie. I have no idea if this is at all related to the call or not.
  24. Updated as of 2020-08-27 (at the bottom of my original post) How long does a higher level review/CUE take? I initially called the 1-800 number and they said supplemental reviews are supposed to take less than 125 days, but they were not certain about higher level reviews. The agent speculated they could take a year or longer. This post was changed to track my claim as it made it's way through the VA system. This may help other veterans understand some of the inner workings of what goes on behind the scenes. Why am I calling this HLR/CUE and not just CUE or HLR? At the time the claims were submitted, other members have indicated filing their CUE claims as regular letters. With the overhaul to the VA claims and appeals process in early 2019, they have became sticklers for filing on certain forms. Unfortunately, there is no mandatory form for a CUE claim. With HLR and CUE being mostly similar, aside from the restrictions of CUE, I wanted to cover my bases and not cause any delays with them having to come back and ask me to use a specific form. HLR/CUE timeline 2019-09-20 Mailed to VA certified mail w/return receipt 2019-09-23 Claim received 2019-10-08 Not yet posted to va.gov. Called 1-800-827-1000. ETA March 2020. 2019-10-17 Moved you evidence gathering, review, and decision as of 2019-10-15. ETA November 4, 2019 2019-10-22 Moved to initial review as of 2019-10-03. ETA March 30, 2020 2019-10-24 Requested records 2019-10-29 va.gov status unchanged. Development letter sent. Called 1-800-827-1000. Claim is in the national work queue and being worked by Houston VARO. The development letter was the typical "we got your claim and are working on it". They sent a request to the Birmingham VAMC for medical treatment records from 1995-1999. Called the VAMC's Release of Information Office and they have 20 business days to complete the request. 2019-11-25 Called 1-800-827-1000. Status still unchanged, but the suspense date of the medical treatment records request has expired. VA agent sent IRIS request. Called the VAMC's Release of Information Office. Paper copies were mailed via USPS certified mail to the Evidence Intake Center in Janesville, WI. They were nice enough to provide the USPS tracking number. 2019-11-29 Certified mail tracking shows package was received by the Evidence Intake Center in Janesville, WI. 2019-12-11 Called 1-800-827-1000. Paper copies have been scanned in to PDF. Waiting to be picked up by a VARO. 2019-12-12 Called 1-800-827-1000. The call center agent (Donald) sent an IRIS request to inform the VARO that the claims are ready to proceed. 2019-12-20 Moved you evidence gathering, review, and decision as of 2019-12-19. ETA January 23, 2020. 2019-12-27 No change to va.gov status. Only change is ETA of May 27, 2020, which is five months out. Called 1-800-827-1000 and was given a strange status. First, they said they were waiting on more medical records from the VAMC from December 20, 2019 through January 20, 2020, which doesn't make much sense. I called back later in the day and was told something different. Called my POA VSO. They said the VA sent me a letter asking if I had any additional evidence to add. The VSO said the ETA is probably out so far because they are waiting for a response from someone outside of the VA system (i.e. me). 2019-12-30 Checked va.gov and noticed it says they sent me a development letter and items need attention. Called 1-800-827-1000 and they said a letter was not sent out and they are not waiting on anything from me. My claim is still at the VARO and assigned to a VSR. They found a note indicating that the recent second request for VAMC medical records was in error. They said they have seen this happen before where it triggers the ETA date to be pushed out automatically. In this case, it cost me about six to seven weeks of unnecessary delay. 2020-01-03 Checked va.gov and no change. Called 1-800-827-1000. The call center rep said it was confusing and transferred me to someone else who could help tell me what is going on. Talked with a friendly lady who said that on 2020-01-02, the person developing the claim sent a message to the quality department asking if the claim should have been submitted on 21-526EZ or 20-0995 (supplemental claim form). Fortunately, earlier today, @Dustoff 11 posted the exact information from M21-1 indicating that no specific form is required. I provided that to the lady and she sent a message to the VARO to let them know exactly where it is. No clue if they have actually processed my request and were just double-checking or if they still need to do it. At least I was able to help them to help me, I hope. 2020-01-07 Well how about this. I received a letter in the mail from the VA yesterday which was dated 2019-12-20 requesting additional evidence (treatment records). Called 1-800-827-1000 and let them know this is for CUE and no new evidence could be added. They did say the request to revise is assigned to a rater, so that's promising. M21-1, Part III, Subpart iv, Chapter 2, Section B - Revision of Decisions III.iv.2.B.4.d. Considering Requests for Revision Based on CUE 2020-01-09 One week has passed since VARO asked about how to proceed regarding filing using a specific form. Called 1-800-827-1000. They said it is now awaiting a decision. Estimated completion date was moved from May 2020 to February 12, 2020, which is an improvement. 2020-01-17 No change on va.gov. Called 1-800-827-1000. They said it was status 499 (National Work Queue), not assigned to an individual and waiting to be picked up. As of 1/8, it is still "Ready for decision". Estimated completion date still February 12, 2020. 2020-01-21 There was a change on va.gov, but it is a bit different than what I have seen previously. The estimated completion date is still February 12, 2020 and the last status was January 8th, but now it also includes three new lines talking about "We closed the notice for Request 1", "We closed the notice for Request 2", and "We closed the notice for Request 3", all dated Jan 8. This was not there last Friday. I'll take it as a good sign that something is happening. I called 1-800-827-1000 to see what these three things are. They said that these indicators were normal, part of what they are doing while clearing things off their checklist. I called my VSO and they confirmed it is "ready for decision", where it has been for the past two weeks. They checked to see if a letter was generated, but one has not been created yet. I also found the answer to my question (sort of) about the "We closed the notice for Request #". I just clicked on the "Files" header at the top. And it showed more information about each request. It's more than what the agent on the phone provided, but it still doesn't give much transparency. For example, "Recent treatment for claimed conditions" was probably the request from the VARO to the VAMC for my medical records. However, because it was CUE, the request was probably not needed because they merely needed to check my claims file. 2020-01-23 I had to call 1-800-827-1000 to check on something unrelated, so I asked them to give me a status update. The decision was made yesterday and is presently waiting for final review (i.e. approval). Once that is done, it will move to notiification. At that point, a decision letter should be inserted into the system and become visible to my VSO so I don't have to wait for it to arrive in the mail. 2020-01-24 Friday afternoon and I checked va.gov and there was a change. Or was there? it was in step 3 yesterday and is still there today. Maybe sometimes between then and now, it was moved to step 4, but then moved back to step 3. The only visible change is the estimated completion date being pushed out by two days. No big deal. I'd rather they take a couple of extra days to get it right (I just hope they get it right). To satisfy my curiosity, I called 1-800-827-1000 to find out if that was what really happened. The first agent I spoke with was clueless and said they could not tell me anything more than what I saw on va.gov. They transferred me to a "technician", who provided a little more info, but was rather rude and made me feel like I was preventing him from leaving for the day. He said the decision was completed and they are in the process of generating the formal notification letter. He said it should be in step 4 Preparation for notification, but indicated that va.gov and ebenefits may not reflect the current status in realtime. Either way, the estimated completion date was still January 30, 2020, what I can see in va.gov. 2020-01-27 I guess someone at the VA was working over the weekend. Finally reached step 4: Preparation for notification and the estimated completion date was moved one day earlier to January 29, 2020. 2020-01-27 Decided to check va.gov before leaving for the day. This confirms what I was told earlier today! Tomorrow, I will ask my VSO to print a copy of the rating decision. 2020-01-28 Picked up rating decision from VSO. As expected, won one, lost one, but the one I lost will be appealed. They made the exact same mistake as in the original claim. 2020-08-27 HLR update and a recap My HLR was received by the VA on April 10, 2020 and has been sitting idle in the national work queue. Today, I received a call from the DRO to perform the informal conference regarding the TMJ errors. He went over the details of the evidence he is allowed to consider (all evidence of record prior to when the decision was made in early 2000). In this case, the VA did a C&P dental TMJ exam in November 1997, but they misplaced the notes and brought me back about a month later for a second exam. When the rating decision was made in early 2000, they only used the material from the second exam. About 8 or 9 years ago, I requested a copy of my claims folder and received it a huge box. I scanned hundreds of pages, front and back, into my computer and organized them. When I had a heart attack in April 2019, I was out of work for several months to recover. I spent a good bit of that time going back over the documents looking for anything which might qualify as a CUE. As a result, I found the misplaced first C&P exam notes. I put together CUE motion and sent it to the VA in Sep 2019 for two issues. In Jan 2020, I won one, but lost the other. I took my time re-reviewing everything and filed the HLR in April 2020. The DRO was able to see my copy of the first C&P exam notes from my packet, but needed to confirm that they were actually in VBMS already. Being handwritten, he had to go page by page and eventually found it. The document was jammed into a packet of 50+ scanned pages that were date stamped as being received by the VARO in March 1999. He felt that when the decision was made in early 2000, the adjudicator probably was looking for transcribed findings placed on a formal C&P exam worksheet, not a handwritten progress note. However, because the first exam was so thorough, he is able to use it's contents. He said DeLuca (4.40 and 4.45) definitely applies because numerous requirements of limitation of motion have been well documented. The first exam would indeed yield a 30% initial rating, but the second exam would only yield a 20% rating. Based on his findings, he feels that I should probably get awarded the 30% because had the material not been misplaced in error, the second exam would have never occurred. He confirmed that CUE definitely did occur. He has to write up the rating narrative and will pass it on for review, claim approval, and any retro approval. The decision letter might be available in a couple of weeks. Due to the other CUE I won in Jan 2000, I was increased to 50% as of 1995. I should be increased to at least 60% from 1995 through 2008 or 2009. The entire conversation lasted almost 90 minutes. I also asked him how HLR's are assigned from the National Work Queue. He said they they are assigned centrally. He saw I had my other HLR in the queue, but he is not allowed to request it. He said the HLRs are assigned to his individual work queue. For example, he may have 7 or 8 assigned to him at any given time. If he finishes up two in one day, two more are automatically assigned at the end of his individual work queue. This news is a great relief, but as always, I will believe it when I see it. Crossing my fingers...
  25. So anyone who utilizes an attorney or VSO might be able to chime in here. I am curious as to the benefit or reason you would HLR a claim that was won? Quality assurance (LOL)? Do HLR usually require a contention of something to file it?
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